Provider Demographics
NPI:1013591999
Name:ANDERSON, SERYNA G (LPN)
Entity Type:Individual
Prefix:
First Name:SERYNA
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SAM WEBB LOOP
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:LA
Mailing Address - Zip Code:71462-2493
Mailing Address - Country:US
Mailing Address - Phone:318-947-2181
Mailing Address - Fax:
Practice Address - Street 1:475 SAM WEBB LOOP
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:LA
Practice Address - Zip Code:71462-2493
Practice Address - Country:US
Practice Address - Phone:318-947-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30001087164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse