Provider Demographics
NPI:1912651704
Name:NAZAIRE, ISRAELITE (LVN)
Entity Type:Individual
Prefix:
First Name:ISRAELITE
Middle Name:
Last Name:NAZAIRE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ISRAELITE
Other - Middle Name:
Other - Last Name:NAZAIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:3304 BALBOA WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2252
Mailing Address - Country:US
Mailing Address - Phone:512-600-3383
Mailing Address - Fax:512-856-9483
Practice Address - Street 1:3304 BALBOA WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2252
Practice Address - Country:US
Practice Address - Phone:512-600-3383
Practice Address - Fax:512-856-9483
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300458164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse