Provider Demographics
NPI:1750913869
Name:SVOBODA, DEAN (RN)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6304
Mailing Address - Country:US
Mailing Address - Phone:985-879-3966
Mailing Address - Fax:
Practice Address - Street 1:420 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6304
Practice Address - Country:US
Practice Address - Phone:985-879-3966
Practice Address - Fax:985-872-4473
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA061165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse