Provider Demographics
NPI:1447753397
Name:DIBBLE, JAMES MALFRED SR (LPN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MALFRED
Last Name:DIBBLE
Suffix:SR
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 1:828 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5216
Mailing Address - Country:US
Mailing Address - Phone:504-407-9105
Mailing Address - Fax:
Practice Address - Street 1:2235 POYDRAS ST STE B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7561
Practice Address - Country:US
Practice Address - Phone:504-524-7205
Practice Address - Fax:504-581-4702
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA760810164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty