Individual
JACKLYN CORINE DEGRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5662 ANGELO DR, LOOMIS, CA 95650-8729
(916) 849-0055
Mailing address
5662 ANGELO DR, LOOMIS, CA 95650-8729
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN276810
CA
Other
Enumeration date
12/21/2019
Last updated
12/21/2019
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