Provider Demographics
NPI:1659928075
Name:DEAN, CEARA JENELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CEARA
Middle Name:JENELLE
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CEARA
Other - Middle Name:JENELLE
Other - Last Name:HEAVENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:98 POLK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-1253
Mailing Address - Country:US
Mailing Address - Phone:920-659-1371
Mailing Address - Fax:
Practice Address - Street 1:98 POLK ST
Practice Address - Street 2:
Practice Address - City:NORTH FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-1253
Practice Address - Country:US
Practice Address - Phone:920-659-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse