Provider Demographics
NPI:1689412736
Name:DEARBORN HOMES INC.
Entity type:Organization
Organization Name:DEARBORN HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TISUNGANE
Authorized Official - Middle Name:BLESSING
Authorized Official - Last Name:CHIWEMBU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:251-533-0642
Mailing Address - Street 1:1200 GRANDE OAK BLVD APT 1102
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3741
Mailing Address - Country:US
Mailing Address - Phone:251-533-0642
Mailing Address - Fax:
Practice Address - Street 1:3151-A KNOLLWOOD DRIVE
Practice Address - Street 2:MOBILE, AL 36693
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693
Practice Address - Country:US
Practice Address - Phone:251-661-7608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty