Individual
JANNA NICKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1213 DURHAM DRIVE, HOUSTON, TX 77007
(713) 636-9138
(281) 888-6510
Mailing address
400 OLD GRANDE BLVD APT 1801, TYLER, TX 75703-4175
(832) 978-8621
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
310500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
310500
LVN LICENSE
TX
Enumeration date
08/28/2016
Last updated
05/24/2019
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