Provider Demographics
NPI:1023672235
Name:HADDERTON, RAEANNA PAIGE (LVN)
Entity type:Individual
Prefix:
First Name:RAEANNA
Middle Name:PAIGE
Last Name:HADDERTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7562 CASBURN CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-3319
Mailing Address - Country:US
Mailing Address - Phone:940-229-8344
Mailing Address - Fax:
Practice Address - Street 1:7562 CASBURN CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3319
Practice Address - Country:US
Practice Address - Phone:940-229-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317317164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse