Provider Demographics
NPI:1104301902
Name:VISE, JANNAH HOLLEY (L AC)
Entity type:Individual
Prefix:
First Name:JANNAH
Middle Name:HOLLEY
Last Name:VISE
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 COMMON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3561
Mailing Address - Country:US
Mailing Address - Phone:512-569-9178
Mailing Address - Fax:
Practice Address - Street 1:190 CRAZY HORSE TRAIL
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133
Practice Address - Country:US
Practice Address - Phone:512-569-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist