Provider Demographics
NPI:1265589352
Name:VERNON, ARDEAN G (REGISTERD NURSE)
Entity type:Individual
Prefix:MRS
First Name:ARDEAN
Middle Name:G
Last Name:VERNON
Suffix:
Gender:F
Credentials:REGISTERD NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HOUSING NEW COMPOUND
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0488
Mailing Address - Country:US
Mailing Address - Phone:605-747-5489
Mailing Address - Fax:
Practice Address - Street 1:ROSEBUD IHS HOSPITAL
Practice Address - Street 2:SOLDIER CREEK ROAD
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-3245
Practice Address - Fax:605-747-5348
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE36469163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse