Provider Demographics
NPI:1518992700
Name:NORMAN, JUANITA (RN)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:
Other - Last Name:FULBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 GARNER LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4137
Mailing Address - Country:US
Mailing Address - Phone:903-234-1716
Mailing Address - Fax:903-234-1716
Practice Address - Street 1:1520 GARNER LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4137
Practice Address - Country:US
Practice Address - Phone:903-234-1716
Practice Address - Fax:903-234-1716
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254457163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator