Provider Demographics
NPI:1700031655
Name:DIBLEY, TINA LOUISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LOUISE
Last Name:DIBLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:DIBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:30844 CAREFREE LN
Mailing Address - Street 2:
Mailing Address - City:FRAZEE
Mailing Address - State:MN
Mailing Address - Zip Code:56544
Mailing Address - Country:US
Mailing Address - Phone:218-841-3957
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL67103-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse