Individual
JAMIE DETELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
LVN
Contact information
Practice address
1687 YULUPA AVE, SANTA ROSA, CA 95405-7778
(707) 546-6183
(707) 528-8027
Mailing address
1609 DEL ORO CIR, PETALUMA, CA 94954-5728
(707) 393-7778
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
725390
CA
Other
Enumeration date
09/02/2025
Last updated
09/02/2025
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