Provider Demographics
NPI:1053638353
Name:ENRIQUEZ, KELLI MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MARIE
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SAINT GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-3910
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:830-672-6430
Practice Address - Street 1:228 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3910
Practice Address - Country:US
Practice Address - Phone:830-672-6511
Practice Address - Fax:830-672-6430
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206977164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse