Provider Demographics
NPI:1750916680
Name:JILEK, AMANDA MARIA (LVN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIA
Last Name:JILEK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 NAKOOSA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2036
Mailing Address - Country:US
Mailing Address - Phone:210-649-0716
Mailing Address - Fax:
Practice Address - Street 1:1128 NAKOOSA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-2036
Practice Address - Country:US
Practice Address - Phone:210-649-0716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352740164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse