=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033687439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEBRA VIDRINE, HEALTH CARE SERVICES,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2018
-----------------------------------------------------
Last Update Date | 11/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1535 W MAIN ST STE 100
-----------------------------------------------------
City | VILLE PLATTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70586-2867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-363-5592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1039 RIVER BIRCH LN
-----------------------------------------------------
City | VILLE PLATTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70586-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-831-1416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | DEBRA VIDRINE HOPE VIDRINE
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 337-363-5592
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------