Provider Demographics
NPI:1114241742
Name:MCBROOM, JENNIFER (LVN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MCBROOM
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 1:4141 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2113
Mailing Address - Country:US
Mailing Address - Phone:713-947-3100
Mailing Address - Fax:713-947-6103
Practice Address - Street 1:4141 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2113
Practice Address - Country:US
Practice Address - Phone:713-947-3100
Practice Address - Fax:713-947-6103
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191294164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse