Healthcare Provider Details

I. General information

NPI: 1134756083
Provider Name (Legal Business Name): MADISONNE LOUISE MEREDITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7014 SAINT CHARLES AVE APT G
NEW ORLEANS LA
70118-3546
US

IV. Provider business mailing address

7014 SAINT CHARLES AVE APT G
NEW ORLEANS LA
70118-3546
US

V. Phone/Fax

Practice location:
  • Phone: 225-892-7699
  • Fax:
Mailing address:
  • Phone: 225-892-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number912087
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN154369
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number226280
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: