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NPI Code Detail

MEDICARE: IRIEL P RODOSTA MSN, APRN, FNP-C

MEDICARE: IRIEL P RODOSTA MSN, APRN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN152571LA
2363L00000XNurse Practitioner230763LA

General Provider Information

NPI Number : 1356035364
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRIEL P RODOSTA MSN, APRN, FNP-C
Provider Business Mailing Address
First Line : 16445 OAKVIEW DR
Second Line :
City : PRAIRIEVILLE
State : LA
Zip : 70769-4844
Country : US
Telephone Number : 225-439-8846
Fax Number :
Provider Business Practice Location Address
First Line : 4212 BLUEBONNET BLVD STE A
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-9675
Country : US
Telephone Number : 225-399-0001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2023
Last Update Date : 06/09/2023

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