Provider Demographics
NPI:1629617428
Name:CARDEN, DEIDRE JANE (LVN)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:JANE
Last Name:CARDEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 CAMELLIA CIR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2732
Mailing Address - Country:US
Mailing Address - Phone:254-760-2586
Mailing Address - Fax:
Practice Address - Street 1:3222 CAMELLIA CIR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2732
Practice Address - Country:US
Practice Address - Phone:254-760-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164775164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse