Provider Demographics
NPI:1548741218
Name:BOLEWARE, JESSICA E (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:BOLEWARE
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 1:138 GEORGIA PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1406
Mailing Address - Country:US
Mailing Address - Phone:361-648-0106
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DR STE 144
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4322
Practice Address - Country:US
Practice Address - Phone:361-854-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224102164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse