Provider Demographics
NPI:1760982649
Name:JASSO, DAISY MARILYN (LVN)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:MARILYN
Last Name:JASSO
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 1:3931 ROCHELLE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1813
Mailing Address - Country:US
Mailing Address - Phone:214-355-8265
Mailing Address - Fax:
Practice Address - Street 1:3931 ROCHELLE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1813
Practice Address - Country:US
Practice Address - Phone:214-355-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340167164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse