Healthcare Provider Details

I. General information

NPI: 1770062549
Provider Name (Legal Business Name): JENNIFER MARIE HAHN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER MARIE NELSON

II. Dates (important events)

Enumeration Date: 08/12/2018
Last Update Date: 08/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 BERGER RD
VICTORIA TX
77905-5208
US

IV. Provider business mailing address

801 E NEWMAN ST
CUERO TX
77954-3176
US

V. Phone/Fax

Practice location:
  • Phone: 361-935-9845
  • Fax:
Mailing address:
  • Phone: 361-935-9845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number224057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: