Individual
JEANITA ELLINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23848 LONE PINE DR, MORENO VALLEY, CA 92557-2947
(951) 490-3659
Mailing address
23848 LONE PINE DR, MORENO VALLEY, CA 92557-2947
(951) 490-3659
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN 208434
CA
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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