Provider Demographics
NPI:1245526409
Name:OLDHAM, ANTHONY EUGENE (LPN)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:EUGENE
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 NASHVILLE PIKE APT 331
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6017
Mailing Address - Country:US
Mailing Address - Phone:615-887-1393
Mailing Address - Fax:
Practice Address - Street 1:2325 NASHVILLE PIKE APT 331
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6017
Practice Address - Country:US
Practice Address - Phone:615-887-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000071489164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse