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Individual
MRS. JAIMIE DESROCHE REVON
Active
Individual
MRS. JAIMIE DESROCHE REVON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
2-0160813
LA
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881864
—
LA
Enumeration date
08/03/2020
Last updated
08/03/2020
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