Provider Demographics
NPI:1306367446
Name:LAURENT, MARIE GERDA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:GERDA
Last Name:LAURENT
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 1:1801 THORMAN AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-5764
Mailing Address - Country:US
Mailing Address - Phone:321-960-0957
Mailing Address - Fax:
Practice Address - Street 1:1801 THORMAN AVE SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-5764
Practice Address - Country:US
Practice Address - Phone:321-960-0957
Practice Address - Fax:321-960-0957
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5187723PN251E00000X
FLPN5187723164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty