Individual
ANGELIA MARIE JAQUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4603 AIRWAY RD, DAYTON, OH 45431-1332
(937) 414-2864
Mailing address
4603 AIRWAY RD, DAYTON, OH 45431-1332
(937) 414-2864
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN-135783-IV
OH
Other
Enumeration date
09/09/2009
Last updated
09/09/2009
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