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Registrant NPI Number: 1194172999

Individual Registrant:
Gender: F
Sole Proprietor

Location and contact information for practice:
77900 JANIE LN  MARINGOUIN, LA 70757-3027 US
Tel: 225-776-0277  Fax: --

Contact information for business:
77900 JANIE LN  MARINGOUIN, LA 70757-3027 US
Tel: 225-776-0277  Fax: --

Registration Information:
NPI: 1194172999
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y176B00000XOther Service Providers

Legacy codes, insurance codes and state license numbers:



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