Provider Demographics
NPI:1245899475
Name:OBERHART, DARIN D (LPN, LMT)
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:D
Last Name:OBERHART
Suffix:
Gender:M
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4924
Mailing Address - Country:US
Mailing Address - Phone:563-528-5711
Mailing Address - Fax:
Practice Address - Street 1:1737 GRANT ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4924
Practice Address - Country:US
Practice Address - Phone:563-528-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083354225700000X
IAP29320164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse