Provider Demographics
NPI:1396214664
Name:ANDRADE, JAMIE MARLENE (LPN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARLENE
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2158
Mailing Address - Country:US
Mailing Address - Phone:209-851-6002
Mailing Address - Fax:
Practice Address - Street 1:3141 WENTWORTH DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2158
Practice Address - Country:US
Practice Address - Phone:209-851-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275722164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse