Provider Demographics
NPI:1932758893
Name:BINGHAM, JANET SUE (LVN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:SUE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 TALL TIMBER LOOP
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-7526
Mailing Address - Country:US
Mailing Address - Phone:325-436-9415
Mailing Address - Fax:
Practice Address - Street 1:243 TALL TIMBER LOOP
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-7526
Practice Address - Country:US
Practice Address - Phone:325-436-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133560164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse