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NPI Code Detail

MEDICARE: DEVANNE BRANDI SOURS

MEDICARE:   DEVANNE BRANDI SOURS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist8526LA

General Provider Information

NPI Number : 1710652508
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVANNE BRANDI SOURS
Provider Business Mailing Address
First Line : 810 EUTERPE ST APT 9109
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70130-8626
Country : US
Telephone Number : 575-399-8831
Fax Number :
Provider Business Practice Location Address
First Line : 810 EUTERPE ST APT 9109
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70130-8626
Country : US
Telephone Number : 575-399-8831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2021
Last Update Date : 08/12/2021

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Directions to “ DEVANNE BRANDI SOURS ” Practice Location

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