Basic Information
| Provider Information | |||||||||
| NPI: | 1447753397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIBBLE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MALFRED | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 828 HICKORY ST | ||||||||
| Address2: | |||||||||
| City: | TERRYTOWN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700565216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044079105 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2235 POYDRAS ST STE B | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701197561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045247205 | ||||||||
| FaxNumber: | 5045814702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2018 | ||||||||
| LastUpdateDate: | 03/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 760810 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.