Active NPI
Mary Virginia Disante, RN
- Administrator Registered Nurse
- Lake Charles, LA
National Provider Identifier
1548732332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- RN056471
- Practice address
- 524 Dr Michael Debakey Dr
Lake Charles, LA 70601-5725 - Phone
- (337) 491-7700
- NPI assigned
- Dec 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | RN056471 | LA | Primary |
Addresses
Primary practice location
524 Dr Michael Debakey Dr
Lake Charles, LA 70601-5725
Mailing address
2107 Venus Dr
Bossier City, LA 71112-4425
Phone (318) 470-1339
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN056471 | LA | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545091200000",
"number": "1548732332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2107 VENUS DR",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711124425",
"telephone_number": "318-470-1339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "524 DR MICHAEL DEBAKEY DR",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706015725",
"telephone_number": "337-491-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISANTE",
"first_name": "MARY",
"middle_name": "VIRGINIA",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-18",
"last_updated": "2018-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "LA",
"license": "RN056471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.