Provider Demographics
NPI:1619000106
Name:CALLOWAY-REED, LILLIE JESSINA (RN CNS)
Entity Type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:JESSINA
Last Name:CALLOWAY-REED
Suffix:
Gender:F
Credentials:RN CNS
Other - Prefix:MRS
Other - First Name:LILLIE
Other - Middle Name:C
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN CNS
Mailing Address - Street 1:301 CORETTA DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2653
Mailing Address - Country:US
Mailing Address - Phone:504-436-8365
Mailing Address - Fax:504-436-8365
Practice Address - Street 1:29764 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426-3069
Practice Address - Country:US
Practice Address - Phone:985-986-0016
Practice Address - Fax:985-986-1260
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN028077AP02266261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center