Provider Demographics
NPI:1558920850
Name:KILLOUGH NORALS, ANTONIETTE (LPN)
Entity Type:Individual
Prefix:
First Name:ANTONIETTE
Middle Name:
Last Name:KILLOUGH NORALS
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 1:12451 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6629
Mailing Address - Country:US
Mailing Address - Phone:225-803-1490
Mailing Address - Fax:225-319-4403
Practice Address - Street 1:11445 REIGER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4556
Practice Address - Country:US
Practice Address - Phone:225-361-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA280496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse