Healthcare Provider Details

I. General information

NPI: 1518648153
Provider Name (Legal Business Name): MRS. PASCOL RIDEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 NW EVANGELINE TRWY STE 8
CARENCRO LA
70520-6241
US

IV. Provider business mailing address

PO BOX 456
WASHINGTON LA
70589-0456
US

V. Phone/Fax

Practice location:
  • Phone: 337-308-6242
  • Fax: 337-422-4065
Mailing address:
  • Phone: 337-308-6242
  • Fax: 866-846-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number328495
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: