Basic Information
| Provider Information | |||||||||
| NPI: | 1134569775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRENNAN-LYNCH | ||||||||
| FirstName: | JANNA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13193 CENTRAL AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917104179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095910843 | ||||||||
| FaxNumber: | 9095917226 | ||||||||
| Practice Location | |||||||||
| Address1: | 13193 CENTRAL AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917104179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095910843 | ||||||||
| FaxNumber: | 9095917226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 06/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 549465 | CA | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 549465 | 01 | CA | LICENSE FOR NURSING | OTHER |