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Individual
NICOLEE A JETER
Active
Individual
NICOLEE A JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
PT 35572
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952589228
CARES RES NORTH
CA
Enumeration date
01/10/2011
Last updated
01/10/2011
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