Provider Demographics
NPI:1811597313
Name:STATUM, ARIEL (LPN)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:STATUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3505
Mailing Address - Country:US
Mailing Address - Phone:225-281-4096
Mailing Address - Fax:
Practice Address - Street 1:5550 THOMAS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-7370
Practice Address - Country:US
Practice Address - Phone:225-774-2141
Practice Address - Fax:225-774-2143
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20100084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse