Provider Demographics
NPI:1508087941
Name:HAYDEL, KRISTINA LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNNE
Last Name:HAYDEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4974 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BARATARIA
Mailing Address - State:LA
Mailing Address - Zip Code:70036-5708
Mailing Address - Country:US
Mailing Address - Phone:504-689-4222
Mailing Address - Fax:
Practice Address - Street 1:4974 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BARATARIA
Practice Address - State:LA
Practice Address - Zip Code:70036-5708
Practice Address - Country:US
Practice Address - Phone:504-689-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA70028OtherSTATE LICENSURE