Provider Demographics
NPI:1275512881
Name:MABEY, JOHN DALE JR (RN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DALE
Last Name:MABEY
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SMITH ST S
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:OR
Mailing Address - Zip Code:97918-1140
Mailing Address - Country:US
Mailing Address - Phone:208-739-8304
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TAMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-2460
Practice Address - Fax:808-433-1558
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2000040565RN163W00000X
WARN00153943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse