Provider Demographics
NPI:1073141941
Name:CORMIER, L J
Entity Type:Individual
Prefix:
First Name:L J
Middle Name:
Last Name:CORMIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 LIME CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4310
Mailing Address - Country:US
Mailing Address - Phone:830-928-1738
Mailing Address - Fax:
Practice Address - Street 1:2021 LIME CREEK RD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4310
Practice Address - Country:US
Practice Address - Phone:830-928-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220901164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse