Provider Demographics
NPI:1760948459
Name:MBADJOUN, LOUISE (NURSE)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:MBADJOUN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:MBADJOUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SKILL NURSE
Mailing Address - Street 1:3029 N ALMA SCHOOL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1474
Mailing Address - Country:US
Mailing Address - Phone:480-812-3680
Mailing Address - Fax:480-732-0050
Practice Address - Street 1:3029 N ALMA SCHOOL RD STE 130
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1474
Practice Address - Country:US
Practice Address - Phone:480-812-3680
Practice Address - Fax:480-732-0050
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043780164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse