Provider Demographics
NPI:1679836498
Name:ATTAWAY, VERONICA WILEY (RN)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:WILEY
Last Name:ATTAWAY
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:PO BOX 6412
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-6412
Mailing Address - Country:US
Mailing Address - Phone:318-741-7314
Mailing Address - Fax:318-741-7441
Practice Address - Street 1:3022 OLD MINDEN RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2477
Practice Address - Country:US
Practice Address - Phone:318-741-7314
Practice Address - Fax:318-741-7441
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN71221163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health