Provider Demographics
NPI:1174664932
Name:RAE, JERRE L (LVN)
Entity Type:Individual
Prefix:MRS
First Name:JERRE
Middle Name:L
Last Name:RAE
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 1:7600 W MILITARY DR
Mailing Address - Street 2:# 158
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-1960
Mailing Address - Country:US
Mailing Address - Phone:210-675-3104
Mailing Address - Fax:
Practice Address - Street 1:7600 W MILITARY DR
Practice Address - Street 2:# 158
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1960
Practice Address - Country:US
Practice Address - Phone:210-675-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48780164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse