Provider Demographics
NPI:1033673827
Name:JARAMILLO, GRISEL PORTILLO (RN)
Entity Type:Individual
Prefix:
First Name:GRISEL
Middle Name:PORTILLO
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19517 SAN CHISOLM DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3961
Mailing Address - Country:US
Mailing Address - Phone:915-274-2751
Mailing Address - Fax:
Practice Address - Street 1:19517 SAN CHISOLM DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3961
Practice Address - Country:US
Practice Address - Phone:915-274-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX881608163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty