Healthcare Provider Details

I. General information

NPI: 1487336657
Provider Name (Legal Business Name): DANIELLE LORENO DALFREY MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14513 WATERLOO DR
VENTRESS LA
70783-4107
US

IV. Provider business mailing address

14513 WATERLOO DR
VENTRESS LA
70783-4107
US

V. Phone/Fax

Practice location:
  • Phone: 318-518-6865
  • Fax:
Mailing address:
  • Phone: 318-518-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023005906
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number230177
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number158352
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: