Individual
MS. BRENNA JEAN MEMOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
5998 ALCALA PARK, STUDENT HEALTH CENTER, MAHER HALL 140, SAN DIEGO, CA 92110-2492
(619) 260-4595
(610) 260-2375
Mailing address
5998 ALCALA PARK, STUDENT HEALTH CENTER, MAHER HALL 140, SAN DIEGO, CA 92110-2492
(619) 260-4595
(610) 260-2375
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
716775
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
95008681
CA
363LG0600X
Gerontology Nurse Practitioner
95008681
CA
Other
Enumeration date
02/21/2017
Last updated
03/15/2020
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