Basic Information
| Provider Information | |||||||||
| NPI: | 1487213286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAINE | ||||||||
| FirstName: | LADONNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 264 | ||||||||
| Address2: | |||||||||
| City: | PORT ALLEN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707670264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252473356 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11445 REIGER RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708094556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259329867 | ||||||||
| FaxNumber: | 2259329870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2019 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 280804 | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.