Individual
JACKIE T NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
105 LEMONWOOD AVE, UNIVERSAL CITY, TX 78148-4206
(210) 544-6259
Mailing address
8700 CROWNHILL BLVD STE 300, SAN ANTONIO, TX 78209-1128
(210) 824-5530
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
306512
TX
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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