Provider Demographics
NPI:1568705630
Name:OFFENBAKER, DAVID LEE JR (LVN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:OFFENBAKER
Suffix:JR
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 1:3104 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-2419
Mailing Address - Country:US
Mailing Address - Phone:210-307-5490
Mailing Address - Fax:
Practice Address - Street 1:3104 BROWN AVE
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-2419
Practice Address - Country:US
Practice Address - Phone:210-307-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211639164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse