Provider Demographics
NPI:1912565698
Name:CRESPO, DIONNA
Entity Type:Individual
Prefix:
First Name:DIONNA
Middle Name:
Last Name:CRESPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CHRISTIAN LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1377
Mailing Address - Country:US
Mailing Address - Phone:985-781-7353
Mailing Address - Fax:985-781-7354
Practice Address - Street 1:113 CHRISTIAN LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1377
Practice Address - Country:US
Practice Address - Phone:985-781-7353
Practice Address - Fax:985-781-7354
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA903240363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health