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NPI Code Detail

MEDICARE: DEANNA FREDERICKS HARLESS ACNP

MEDICARE: DEANNA FREDERICKS HARLESS ACNP
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
1363LA2100XAcute Care Nurse PractitionerRN054166 AP03616LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407852288
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA FREDERICKS HARLESS ACNP
Provider Business Mailing Address
First Line : PO BOX 1786
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70602-1786
Country : US
Telephone Number : 337-478-9653
Fax Number : 337-474-0988
Provider Business Practice Location Address
First Line : 1614 WOLF CIR
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-2348
Country : US
Telephone Number : 337-478-9653
Fax Number : 337-474-0988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2005
Last Update Date : 12/16/2009

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