Provider Demographics
NPI:1871683276
Name:LAIN, CASSANDRA (LPN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:LAIN
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 1:3000 EVANGELINE ST
Mailing Address - Street 2:APT NO.208
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3800
Mailing Address - Country:US
Mailing Address - Phone:318-388-1851
Mailing Address - Fax:
Practice Address - Street 1:4781 S GRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6403
Practice Address - Country:US
Practice Address - Phone:318-362-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse