Brenna Jean Memole, AGNP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

95008681 Issued in CA

Practice address

5998 Alcala Park
Student Health Center, Maher Hall 140
San Diego, CA 92110-2492

Phone

(619) 260-4595

Fax

(610) 260-2375

NPI assigned

Feb 21, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of San Diego Student Health Center

  • Student Health Clinic/Center
  • San Diego, CA
  • NPI 1962958561
  NPD (past)
• Columbia University

  • Registered Nurse
  • New York, NY
  • NPI 1407209653
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584230400000",
    "number": "1437698677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5998 ALCALA PARK",
            "address_2": "STUDENT HEALTH CENTER, MAHER HALL 140",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102492",
            "telephone_number": "619-260-4595",
            "fax_number": "610-260-2375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5998 ALCALA PARK",
            "address_2": "STUDENT HEALTH CENTER, MAHER HALL 140",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102492",
            "telephone_number": "619-260-4595",
            "fax_number": "610-260-2375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "617 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323703",
            "country_code": "US",
            "telephone_number": "212-305-5756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "590 Forest Ave",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943012611",
            "country_code": "US",
            "telephone_number": "650-288-4080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "590 Forest Ave",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943012611",
            "country_code": "US",
            "telephone_number": "650-288-4080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEMOLE",
        "first_name": "BRENNA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-21",
        "last_updated": "2020-03-15",
        "certification_date": "2020-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "716775",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95008681",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95008681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Rae Melville
• Samantha Anne Melzer, D.M.D.
• Rachel Membreno Almendaers
• Elseke Margarita Membreno-Zenteno
• Brigham Memmott
• Jessica Memun Sidauy, L.AC.
• Men'S Health and Wellness Center USA PC
• Carina Mena
• Eliza Mena
• Isabella Mena

• Adult Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.