Provider Demographics
NPI:1962971325
Name:FOSTER DEBLANC, JENNIFER LYNN (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:FOSTER DEBLANC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 GAUSE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2853
Mailing Address - Country:US
Mailing Address - Phone:985-326-8501
Mailing Address - Fax:
Practice Address - Street 1:700 GAUSE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2853
Practice Address - Country:US
Practice Address - Phone:985-326-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN153798163WP0809X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult