Provider Demographics
NPI:1447667225
Name:JAQUEZ, ARLENE (LPN)
Entity type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:
Last Name:JAQUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:JAQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1032 SW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:781 GRAND CASINO BLVD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1005
Practice Address - Country:US
Practice Address - Phone:405-964-5770
Practice Address - Fax:405-964-5788
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL64016164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse