Individual
JESSICA NICOLE CHURCHVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
482 4TH AVE, PORTOLA, CA 96122-9235
(702) 209-5809
Mailing address
482 4TH AVE, PORTOLA, CA 96122-9235
(702) 209-5809
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
NV
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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