MEDICARE: LENA DRYDEN CHAISSON RN

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
1	163W00000X	Registered Nurse	RN100009	LA

General Provider Information

NPI Number	:	1962847889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENA DRYDEN CHAISSON RN

Provider Business Mailing Address
First Line	:	18336 LAKE HARBOR LN
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-5272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18336 LAKE HARBOR LN
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-5272
Country	:	US
Telephone Number	:	225-343-9505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	05/06/2013

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