Healthcare Provider Details

I. General information

NPI: 1881701431
Provider Name (Legal Business Name): LATESHA TAVONNE TURNER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEADOW LANE CLSH/RRTC UNIT #6
PINEVILLE LA
71409-0212
US

IV. Provider business mailing address

PO BOX 212 906 MAYO STREET
BOYCE LA
71409-0212
US

V. Phone/Fax

Practice location:
  • Phone: 318-487-5191
  • Fax: 318-487-5184
Mailing address:
  • Phone: 318-793-4913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number260247
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: