Provider Demographics
NPI:1134756083
Name:MEREDITH, MADISONNE LOUISE
Entity type:Individual
Prefix:
First Name:MADISONNE
Middle Name:LOUISE
Last Name:MEREDITH
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 1:7014 SAINT CHARLES AVE APT G
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-3546
Mailing Address - Country:US
Mailing Address - Phone:225-892-7699
Mailing Address - Fax:
Practice Address - Street 1:7014 SAINT CHARLES AVE APT G
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-3546
Practice Address - Country:US
Practice Address - Phone:225-892-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS912087163WM0705X
LARN154369163WM0705X
LA226280367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS912087OtherRN LICENSE
LARN154369OtherRN LICENSE