Provider Demographics
NPI:1275083776
Name:JUCHNIEWICZ, NICOLE (LVN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JUCHNIEWICZ
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 1:934 CALLE LA CUMBRE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3070
Mailing Address - Country:US
Mailing Address - Phone:843-437-5493
Mailing Address - Fax:
Practice Address - Street 1:934 CALLE LA CUMBRE UNIT B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3070
Practice Address - Country:US
Practice Address - Phone:843-437-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685420164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse