Provider Demographics
NPI:1124597968
Name:JUSTICE, ADAEZE MARGARET (LVN)
Entity Type:Individual
Prefix:
First Name:ADAEZE
Middle Name:MARGARET
Last Name:JUSTICE
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 1:1016 RIO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7191
Mailing Address - Country:US
Mailing Address - Phone:469-684-4211
Mailing Address - Fax:
Practice Address - Street 1:1016 RIO VERDE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7191
Practice Address - Country:US
Practice Address - Phone:469-684-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222832164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse