Provider Demographics
NPI:1326743105
Name:READENOUR, DYLAN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:READENOUR
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ALLEN TOUSSAINT BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2860
Mailing Address - Country:US
Mailing Address - Phone:337-296-2009
Mailing Address - Fax:
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-899-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA216251163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology