Healthcare Provider Details

I. General information

NPI: 1043824238
Provider Name (Legal Business Name): MS. LANETTA LYNN RINEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5128 HEMINGWAY DR
DARROW LA
70725-2501
US

IV. Provider business mailing address

5128 HEMINGWAY DR
DARROW LA
70725-2501
US

V. Phone/Fax

Practice location:
  • Phone: 225-717-1297
  • Fax:
Mailing address:
  • Phone: 225-717-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: