Healthcare Provider Details

I. General information

NPI: 1093890089
Provider Name (Legal Business Name): PDN NURSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 AVENUE OF AMERICA BUILDING 5
MONROE LA
71201-4529
US

IV. Provider business mailing address

1859 AVENUE OF AMERICA BUILDING 5
MONROE LA
71201-4529
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-0144
  • Fax: 318-324-0145
Mailing address:
  • Phone: 318-324-0144
  • Fax: 318-324-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number6260
License Number StateLA

VIII. Authorized Official

Name: MR. RUSSELL M STARNS
Title or Position: C.E.O.
Credential:
Phone: 225-262-9741