Provider Demographics
NPI:1669294971
Name:LAURENT, RODELYNE N/A
Entity type:Individual
Prefix:
First Name:RODELYNE
Middle Name:N/A
Last Name:LAURENT
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 1:65 DOUGLAS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3223
Mailing Address - Country:US
Mailing Address - Phone:781-827-9020
Mailing Address - Fax:
Practice Address - Street 1:65 DOUGLAS AVE APT 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3223
Practice Address - Country:US
Practice Address - Phone:781-827-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN1000247164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse