Provider Demographics
NPI: | 1477162451 |
---|---|
Name: | CHAGHOURY, JENNIFER (LVN/CNA/PCH) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | JENNIFER |
Middle Name: | |
Last Name: | CHAGHOURY |
Suffix: | |
Gender: | F |
Credentials: | LVN/CNA/PCH |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 4606 LA MARQUESA ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78233 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-776-3750 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4606 LA MARQUESA ST |
Practice Address - Street 2: | |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78233 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-776-3750 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2020-07-27 |
Last Update Date: | 2020-07-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 372500000X, 372600000X, 374T00000X | |
TX | NA00268312 | 376K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 376K00000X | Nursing Service Related Providers | Nurse's Aide | |
No | 372500000X | Nursing Service Related Providers | Chore Provider | |
No | 372600000X | Nursing Service Related Providers | Adult Companion | |
No | 374T00000X | Nursing Service Related Providers | Religious Nonmedical Nursing Personnel |