Revon, Jaimie Desroche

Revon, Jaimie Desroche is an sole proprietor health care provider with primary practice located at 700 Gause Blvd Ste 201 , Slidell LA 70458-2853. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Nursing Service Providers / Licensed Practical Nurse. Other Service Providers / Case Manager/Care Coordinator is her primary health care specialty. Revon, Jaimie Desroche can be contacted via phone (504) 330-6670.

Contact Information

Primary practice address
700 Gause Blvd Ste 201 Slidell LA 70458-2853
Phone: (504) 330-6670
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X Louisiana
Nursing Service Providers / Licensed Practical Nurse 164W00000X 2-0160813 Louisiana

Profile Details

NPI number 1881204022
LBN Legal business name Revon, Jaimie Desroche
Credentials Licensed Practical Nurse (LPN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 3rd, 2020
Last updated Aug 3rd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881204022 NPPES
Louisiana MEDICAID 1881864

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