Provider Demographics
NPI:1326368101
Name:KAILBURN, DEWEY JAMES (LPN)
Entity Type:Individual
Prefix:MR
First Name:DEWEY
Middle Name:JAMES
Last Name:KAILBURN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:NY
Mailing Address - Zip Code:14485-9405
Mailing Address - Country:US
Mailing Address - Phone:585-739-6434
Mailing Address - Fax:585-624-2011
Practice Address - Street 1:2494 PLANK RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:NY
Practice Address - Zip Code:14485-9405
Practice Address - Country:US
Practice Address - Phone:585-739-6434
Practice Address - Fax:585-624-2011
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10298474164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse