Provider Demographics
NPI:1194806505
Name:REESE, SERENA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:ANN
Last Name:REESE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4781 S GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-6403
Mailing Address - Country:US
Mailing Address - Phone:318-362-5430
Mailing Address - Fax:318-362-3428
Practice Address - Street 1:4781 S GRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6403
Practice Address - Country:US
Practice Address - Phone:318-362-5430
Practice Address - Fax:318-362-3428
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA950770164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse