Individual
MRS. JACQUELINE LACHALLE WHITLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
204 LARAMIE LN, DESOTO, TX 75115-5382
(972) 805-3571
Mailing address
204 LARAMIE LN, DESOTO, TX 75115-5382
(972) 805-3571
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
207692
TX
Other
Enumeration date
03/12/2018
Last updated
03/12/2018
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