Provider Demographics
NPI:1720125495
Name:KLEIN, JENNIFER (MSN FNP RN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MSN FNP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 E. HWY 20
Mailing Address - Street 2:
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458-7885
Mailing Address - Country:US
Mailing Address - Phone:707-274-9299
Mailing Address - Fax:
Practice Address - Street 1:6300 E. HWY 20
Practice Address - Street 2:
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458-7885
Practice Address - Country:US
Practice Address - Phone:707-274-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17190363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner