Most Relevant Information
Provider Data
| NPI Number: | 1003684549 |
| Provider Name: | KAITLYN VERRET ELLENDER |
| Entity Type: | Individual |
| Taxonomy Code: | 163WX0003X |
| Specialty: | Registered Nurse |
| License Number: | 205536 |
Most Important Dates
| Enumeration Date: | 12/14/2023 |
| Last Updated: | 12/14/2023 |
Provider Practice Location
113 SPANISH MOSS LN
BROUSSARD
LA
705187739
Practice Location Phone/Fax
| Phone: | 9857142181 |
| Fax: |
Provider Mailing Location
113 SPANISH MOSS LN
BROUSSARD
LA
705187739
Provider Mailing Phone/Fax
| Phone: | 9857142181 |
| Fax: |