Provider Demographics
NPI:1033624531
Name:LANDRY-PORTER, SHANTELLE RENEE (RN)
Entity type:Individual
Prefix:
First Name:SHANTELLE
Middle Name:RENEE
Last Name:LANDRY-PORTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 E BAMBOO DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5820
Mailing Address - Country:US
Mailing Address - Phone:504-905-9871
Mailing Address - Fax:
Practice Address - Street 1:3901 E BAMBOO DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5820
Practice Address - Country:US
Practice Address - Phone:504-905-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101216163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse