Provider Demographics
NPI:1548078793
Name:LIM, JHISTOPHER PALCO
Entity type:Individual
Prefix:
First Name:JHISTOPHER
Middle Name:PALCO
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 ANNANDALE LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4902
Mailing Address - Country:US
Mailing Address - Phone:304-699-9895
Mailing Address - Fax:
Practice Address - Street 1:4418 ANNANDALE LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-4902
Practice Address - Country:US
Practice Address - Phone:304-699-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116580163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical