Provider Demographics
NPI:1952443400
Name:JAIME, JOSE ANGEL (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:JAIME
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442 BOX 798
Mailing Address - Street 2:
Mailing Address - City:HEIDELBERG
Mailing Address - State:APO
Mailing Address - Zip Code:AE 09042
Mailing Address - Country:DE
Mailing Address - Phone:371-2969
Mailing Address - Fax:371-2320
Practice Address - Street 1:CMR 442 BOX 798
Practice Address - Street 2:PACU
Practice Address - City:HEIDELBERG
Practice Address - State:APO
Practice Address - Zip Code:AE 09042
Practice Address - Country:DE
Practice Address - Phone:371-2969
Practice Address - Fax:371-2320
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1215851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse