Provider Demographics
NPI:1659580652
Name:DEARBORN, CHARLES A (LPN0)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:DEARBORN
Suffix:
Gender:M
Credentials:LPN0
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OUTER DR. N. 323
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 INDIAN HILLS DR.
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:402-837-4216
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP46282164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse