Healthcare Provider Details

I. General information

NPI: 1326860354
Provider Name (Legal Business Name): TAJONNA REDWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LAMY LN
MONROE LA
71201-3737
US

IV. Provider business mailing address

1701 LAMY LN
MONROE LA
71201-3737
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-0240
  • Fax: 318-329-0239
Mailing address:
  • Phone: 318-329-0240
  • Fax: 318-329-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: