Provider Demographics
NPI:1942788930
Name:JIMENEZ, BRENDA (LVN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:JIMENEZ
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 1:2201 LEONARD RD TRLR 38
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-4451
Mailing Address - Country:US
Mailing Address - Phone:979-255-7193
Mailing Address - Fax:
Practice Address - Street 1:2201 LEONARD RD TRLR 38
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-4451
Practice Address - Country:US
Practice Address - Phone:979-255-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344068164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse