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NPI Code Detail

MEDICARE: BROOKE SCHOONENBERG RD, LDN

MEDICARE:   BROOKE  SCHOONENBERG  RD, LDN
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
1133V00000XRegistered Dietitian2488LA

General Provider Information

NPI Number : 1841781457
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE SCHOONENBERG RD, LDN
Provider Business Mailing Address
First Line : 9637 JEFFERSON HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-2632
Country : US
Telephone Number : 225-924-8313
Fax Number :
Provider Business Practice Location Address
First Line : 9637 JEFFERSON HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-2632
Country : US
Telephone Number : 225-924-8313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2018
Last Update Date : 05/21/2018

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Directions to “ BROOKE SCHOONENBERG RD, LDN” Practice Location

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