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General NPI Number Information
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NPI Number | 1306367446
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Entity Type | Individual
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Provider Name | MARIE GERDA LAURENT LPN
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 1801 THORMAN AVE SE
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City | PALM BAY
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State | FL
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Zip | 32909-5764
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Country | US
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Telephone | 321-960-0957
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Fax | 321-960-0957
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Provider Business Mailing Address
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Address Line | 1801 THORMAN AVE SE
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City | PALM BAY
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State | FL
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Zip | 32909-5764
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Country | US
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Telephone | 321-960-0957
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Fax |
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 5187723PN
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5187723
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License Number State | FL
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