Provider Demographics
NPI:1861032690
Name:KIZER, NICOLE (LVN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KIZER
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 1:16631 VANCE JACKSON APT 4312
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-5037
Mailing Address - Country:US
Mailing Address - Phone:210-336-9280
Mailing Address - Fax:
Practice Address - Street 1:16631 VANCE JACKSON APT 4312
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-5037
Practice Address - Country:US
Practice Address - Phone:210-336-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351388164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse