Provider Demographics
NPI:1265178735
Name:REDD, LAURA SYLVE (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SYLVE
Last Name:REDD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59295 REBEL DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3713
Mailing Address - Country:US
Mailing Address - Phone:985-605-5692
Mailing Address - Fax:985-649-9470
Practice Address - Street 1:59295 REBEL DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-3713
Practice Address - Country:US
Practice Address - Phone:985-605-5692
Practice Address - Fax:985-649-9470
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN122683163WE0003X, 163WP0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WP0200XNursing Service ProvidersRegistered NursePediatrics