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General NPI Number Information
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NPI Number | 1871108357
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Entity Type | Individual
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Provider Name | CHARETTE DELLAGATTA RN, CCRP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 1449 E BERT KOUN LOOP STE 102
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City | SHREVEPORT
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State | LA
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Zip | 71105-5663
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Country | US
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Telephone | 318-681-5353
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Fax | 318-681-6305
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Provider Business Mailing Address
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Address Line | 6021 DILLINGHAM AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-2109
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Country | US
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Telephone |
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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 | 163WC3500X
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Taxonomy Name | Cardiac Rehabilitation Registered Nurse
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License Number | RN148778
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | RN148778
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License Number State | LA
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