Provider Demographics
NPI:1073569638
Name:VERDEFLOR, DIANA LOCSIN (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LOCSIN
Last Name:VERDEFLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BUFFALO RUN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6604
Mailing Address - Country:US
Mailing Address - Phone:337-988-5768
Mailing Address - Fax:
Practice Address - Street 1:1009 CHARITY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5302
Practice Address - Country:US
Practice Address - Phone:337-893-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN093366363LF0000X
LAAP04079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136727Medicaid
LA4C442D486Medicare ID - Type Unspecified
LA1136727Medicaid