Provider Demographics
NPI:1306024484
Name:DENHAM, MICKEL DANA (LVN)
Entity Type:Individual
Prefix:MR
First Name:MICKEL
Middle Name:DANA
Last Name:DENHAM
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 VETERANS MEMORIAL CIR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-3011
Mailing Address - Country:US
Mailing Address - Phone:530-822-7215
Mailing Address - Fax:
Practice Address - Street 1:1445 VETERANS MEMORIAL CIR
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-3011
Practice Address - Country:US
Practice Address - Phone:530-822-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 202508164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse