Healthcare Provider Details

I. General information

NPI: 1306024484
Provider Name (Legal Business Name): MICKEL DANA DENHAM LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 VETERANS MEMORIAL CIR
YUBA CITY CA
95993-3011
US

IV. Provider business mailing address

1445 VETERANS MEMORIAL CIR
YUBA CITY CA
95993-3011
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7240
  • Fax:
Mailing address:
  • Phone: 530-822-7215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberVN 202508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: