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NPI Code Detail

MEDICARE: CODIE C BRIAN RN

MEDICARE: CODIE C BRIAN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN134265LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN134265OTHERLARN LICENSE

General Provider Information

NPI Number : 1528624020
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODIE C BRIAN RN
Provider Business Mailing Address
First Line : PO BOX 395
Second Line :
City : CLINTON
State : LA
Zip : 70722-0395
Country : US
Telephone Number : 225-683-5292
Fax Number : 225-683-1310
Provider Business Practice Location Address
First Line : 3170 CHURCH ST
Second Line :
City : SLAUGHTER
State : LA
Zip : 70777
Country : US
Telephone Number : 225-683-1370
Fax Number : 225-683-1379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2019
Last Update Date : 05/10/2019

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