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NPI Code Detail

MEDICARE: MS. ARLENE JAQUEZ LPN

MEDICARE: MS. ARLENE JAQUEZ LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseL64016OK

General Provider Information

NPI Number : 1447667225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ARLENE JAQUEZ LPN
Provider Business Mailing Address
First Line : 1032 SW 61ST ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-1208
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 781 GRAND CASINO BLVD
Second Line :
City : SHAWNEE
State : OK
Zip : 74804-1005
Country : US
Telephone Number : 405-964-5770
Fax Number : 405-964-5788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2014
Last Update Date : 07/17/2014

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Directions to “ MS. ARLENE JAQUEZ LPN” Practice Location

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