Individual
JERRIE DENISE SAN LUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1110 W WILLIAM CANNON DR STE 303, AUSTIN, TX 78745-3188
(512) 899-2100
(512) 899-2205
Mailing address
1110 W WILLIAM CANNON DR STE 303, AUSTIN, TX 78745-3188
(512) 899-2100
(512) 899-2205
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
652119
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
652119
NURSE LICENSE-REGISTERED NURSE
TX
Enumeration date
03/25/2022
Last updated
03/25/2022
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