Individual
JERRI KHAMMANH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4965 BETTY MAE DR, STOCKTON, CA 95212-3040
(209) 487-3299
Mailing address
4965 BETTY MAE DR, STOCKTON, CA 95212-3040
(209) 487-3299
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN 291389
CA
Other
Enumeration date
06/08/2016
Last updated
06/08/2016
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