Provider Demographics
NPI:1982857603
Name:LEYVA, CARMEN (LVN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:LEYVA
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:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-0755
Mailing Address - Country:US
Mailing Address - Phone:806-935-9005
Mailing Address - Fax:806-935-5885
Practice Address - Street 1:202 S MEREDITH AVE
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3837
Practice Address - Country:US
Practice Address - Phone:806-935-9005
Practice Address - Fax:806-935-5885
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59476164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse