Provider Demographics
NPI:1851988646
Name:LAURENT, SAMUEL ALEXADNER
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ALEXADNER
Last Name:LAURENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 DOVE PARK RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6335
Mailing Address - Country:US
Mailing Address - Phone:985-774-9633
Mailing Address - Fax:
Practice Address - Street 1:1144 DOVE PARK RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6335
Practice Address - Country:US
Practice Address - Phone:985-778-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies