Provider Demographics
NPI:1881250876
Name:KURUVILLA, JAISON (RN)
Entity type:Individual
Prefix:
First Name:JAISON
Middle Name:
Last Name:KURUVILLA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 HELEN LN
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1862
Mailing Address - Country:US
Mailing Address - Phone:214-263-7236
Mailing Address - Fax:
Practice Address - Street 1:2804 HELEN LN
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1862
Practice Address - Country:US
Practice Address - Phone:214-263-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health