Provider Demographics
NPI:1407076581
Name:SOUTH, DENISE MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:SOUTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60685 430TH ST
Mailing Address - Street 2:
Mailing Address - City:SEBEKA
Mailing Address - State:MN
Mailing Address - Zip Code:56477
Mailing Address - Country:US
Mailing Address - Phone:218-837-6044
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0488130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse