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General NPI Number Information
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NPI Number | 1265506984
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Entity Type | Individual
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Provider Name | DEBRA VIDRINE APRN
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 1015 SANDERS
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City | PINE PRAIRIE
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State | LA
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Zip | 70576-3611
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Country | US
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Telephone | 337-599-2212
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Fax | 337-546-0071
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Provider Business Mailing Address
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Address Line | PO BOX 65205
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City | BATON ROUGE
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State | LA
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Zip | 70896-5205
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Country | US
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Telephone | 337-546-0101
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Fax | 337-546-0071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN039129 APO4342
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License Number State | LA
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