Provider Demographics
NPI:1932756558
Name:JAWOD, IRES JOY
Entity Type:Individual
Prefix:
First Name:IRES JOY
Middle Name:
Last Name:JAWOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 PENDLETON DR APT 221
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2626
Mailing Address - Country:US
Mailing Address - Phone:979-218-4305
Mailing Address - Fax:
Practice Address - Street 1:4150 PENDLETON DR APT 221
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2626
Practice Address - Country:US
Practice Address - Phone:979-218-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX968307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty