Provider Demographics
NPI:1497072839
Name:DOVE, CHRIS DALE (LPN)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:DALE
Last Name:DOVE
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 1:1615 MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9248
Mailing Address - Country:US
Mailing Address - Phone:740-703-4589
Mailing Address - Fax:
Practice Address - Street 1:1615 MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9248
Practice Address - Country:US
Practice Address - Phone:740-703-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-112922164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse