Provider Demographics
NPI:1801202460
Name:VIDRINE, DAWANA MARY (LPN)
Entity Type:Individual
Prefix:
First Name:DAWANA
Middle Name:MARY
Last Name:VIDRINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DAWANA
Other - Middle Name:MARY
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:312 COURT ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5248
Mailing Address - Country:US
Mailing Address - Phone:337-363-5525
Mailing Address - Fax:
Practice Address - Street 1:220 S MARKET ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5140
Practice Address - Country:US
Practice Address - Phone:337-948-0226
Practice Address - Fax:337-948-0399
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA840329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse