Provider Demographics
NPI:1831605112
Name:HARRELL PIPPINS, MICHELLE LATESSA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LATESSA
Last Name:HARRELL PIPPINS
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 1:114 INEICHEN ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3223
Mailing Address - Country:US
Mailing Address - Phone:318-417-7780
Mailing Address - Fax:318-728-1140
Practice Address - Street 1:114 INEICHEN ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3223
Practice Address - Country:US
Practice Address - Phone:318-417-7780
Practice Address - Fax:318-728-1140
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA980251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse