Individual
DEANNA FREDERICKS HARLESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
1614 WOLF CIR, LAKE CHARLES, LA 70605-2348
(337) 478-9653
(337) 474-0988
Mailing address
PO BOX 1786, LAKE CHARLES, LA 70602-1786
(337) 478-9653
(337) 474-0988
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN054166 AP03616
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1436461
—
LA
Enumeration date
06/24/2005
Last updated
12/16/2009
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