Provider Demographics
NPI:1225212350
Name:EARHART, DANA M (LPN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:EARHART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 SPRING STREET
Mailing Address - Street 2:ATTN. DANA EARHART, SCHOOL NURSE
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058
Mailing Address - Country:US
Mailing Address - Phone:931-232-7235
Mailing Address - Fax:931-232-4608
Practice Address - Street 1:723 SPRING STREET
Practice Address - Street 2:ATTN. DANA EARHART, SCHOOL NURSE
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058
Practice Address - Country:US
Practice Address - Phone:931-232-7235
Practice Address - Fax:931-232-4608
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51442164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN51442OtherLPN