Provider Demographics
NPI:1417779174
Name:SACKO, EVELYN LOUISE (LVN)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:LOUISE
Last Name:SACKO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:LOUISE
Other - Last Name:MCCRIMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:9939 SH 151
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1900
Mailing Address - Country:US
Mailing Address - Phone:210-706-7800
Mailing Address - Fax:
Practice Address - Street 1:9939 SH 151
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1900
Practice Address - Country:US
Practice Address - Phone:210-706-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200317164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse