Provider Demographics
NPI:1700800836
Name:CARMICKLE, PAUL LELAND III (LPN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:LELAND
Last Name:CARMICKLE
Suffix:III
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 1:249 TIMBER WOLF CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4316
Mailing Address - Country:US
Mailing Address - Phone:301-524-7044
Mailing Address - Fax:
Practice Address - Street 1:BLD 510 PARKS RFTA
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:925-875-4037
Practice Address - Fax:925-875-4028
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN216078164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse