Provider Demographics
NPI:1437803814
Name:SADICON, JUELLA (APRN)
Entity Type:Individual
Prefix:
First Name:JUELLA
Middle Name:
Last Name:SADICON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 FIRST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3634
Mailing Address - Country:US
Mailing Address - Phone:629-239-3961
Mailing Address - Fax:
Practice Address - Street 1:4302 FIRST VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3634
Practice Address - Country:US
Practice Address - Phone:210-305-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1077694363LP0808X
TN31147363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty