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Individual

LASHAUNDA RENEE JETHRO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP, DNP

Contact information

Practice address
4290 POLK AVE, SAN DIEGO, CA 92105-1524
(619) 563-0250
(858) 633-4681
Mailing address
31378 BRUSH CREEK CIR, TEMECULA, CA 92591-7418
(618) 789-1081

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95127420
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP95017852
CA

Other

Enumeration date
06/25/2021
Last updated
08/05/2021
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