Provider Demographics
NPI:1417627258
Name:DONELLAN, RICHELE LAYNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RICHELE
Middle Name:LAYNE
Last Name:DONELLAN
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 1:34999 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-2709
Mailing Address - Country:US
Mailing Address - Phone:225-802-6295
Mailing Address - Fax:
Practice Address - Street 1:8444 CECIL DR
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-1244
Practice Address - Country:US
Practice Address - Phone:225-664-3211
Practice Address - Fax:225-664-1551
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA220103164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse