Provider Demographics
NPI:1003149782
Name:PEARSON, DENA COLLEEN (LVN)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:COLLEEN
Last Name:PEARSON
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 1:1000 ALLISON DR APT 142
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4986
Mailing Address - Country:US
Mailing Address - Phone:707-365-6503
Mailing Address - Fax:
Practice Address - Street 1:1000 ALLISON DR APT 142
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4986
Practice Address - Country:US
Practice Address - Phone:707-365-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN238707164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse