Provider Demographics
NPI:1871629436
Name:DAYTON, MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DAYTON
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 1:500 RODERICK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-2247
Mailing Address - Country:US
Mailing Address - Phone:985-380-2460
Mailing Address - Fax:985-380-2475
Practice Address - Street 1:118 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-5713
Practice Address - Country:US
Practice Address - Phone:985-380-2460
Practice Address - Fax:985-380-2475
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA940517164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA940517OtherLPN LIC NUMBER