Provider Demographics
NPI:1740973882
Name:NEAL, CALVIN BERNARD SR (LPN)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:BERNARD
Last Name:NEAL
Suffix:SR
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 1:13631 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7828
Mailing Address - Country:US
Mailing Address - Phone:706-326-5443
Mailing Address - Fax:
Practice Address - Street 1:13631 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7828
Practice Address - Country:US
Practice Address - Phone:706-326-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN043985164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse