Healthcare Provider Details

I. General information

NPI: 1528605748
Provider Name (Legal Business Name): NIA CHANTALE MARSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST
BAKER LA
70714-3767
US

IV. Provider business mailing address

350 MAIN ST
BAKER LA
70714-3767
US

V. Phone/Fax

Practice location:
  • Phone: 225-778-6783
  • Fax: 225-612-6602
Mailing address:
  • Phone: 225-778-6783
  • Fax: 225-612-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: