Provider Demographics
NPI:1396388252
Name:NERVE, DEIDRA
Entity Type:Individual
Prefix:MISS
First Name:DEIDRA
Middle Name:
Last Name:NERVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4120
Mailing Address - Country:US
Mailing Address - Phone:337-255-6090
Mailing Address - Fax:
Practice Address - Street 1:205 TALBOT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-4120
Practice Address - Country:US
Practice Address - Phone:337-255-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA290995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
290995OtherLICENSE #