Healthcare Provider Details

I. General information

NPI: 1417286261
Provider Name (Legal Business Name): DEE ANN VINES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 LAUREL ST
BEAUMONT TX
77707-2216
US

IV. Provider business mailing address

3650 LAUREL ST
BEAUMONT TX
77707-2216
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-0346
  • Fax: 409-924-4951
Mailing address:
  • Phone: 409-838-0346
  • Fax: 409-924-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number137164
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: