Individual
MS. IRENE LOISE NICELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1111 CRESTDALE ST, JACKSONVILLE, FL 32211-5709
(904) 710-1011
Mailing address
1111 CRESTDALE ST, JACKSONVILLE, FL 32211-5709
(904) 710-1011
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5157580
FL
Other
Enumeration date
12/15/2006
Last updated
07/08/2007
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