Individual
MRS. JACQUELINE LEE CASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1808 POPPY LN, CERES, CA 95307-2227
(209) 483-9809
(209) 824-2805
Mailing address
647 WARD WAY, MANTECA, CA 95336-3247
(209) 483-9809
(209) 824-2805
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN 149864
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EPS006020
MEDI-CAL
CA
Enumeration date
10/28/2006
Last updated
07/08/2007
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