Provider Demographics
NPI:1699373613
Name:VARNADO, REBECCA HENTZE (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HENTZE
Last Name:VARNADO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70292 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5351
Mailing Address - Country:US
Mailing Address - Phone:504-915-1582
Mailing Address - Fax:
Practice Address - Street 1:1051 GAUSE BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2988
Practice Address - Country:US
Practice Address - Phone:985-641-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily