Healthcare Provider Details

I. General information

NPI: 1205892460
Provider Name (Legal Business Name): FAITH HANSBROUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CONSTANTIN BLVD STE 220
BATON ROUGE LA
70809-3481
US

IV. Provider business mailing address

7777 HENNESSY BLVD SUITE 212
BATON ROUGE LA
70808
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-2295
  • Fax: 225-769-2297
Mailing address:
  • Phone: 225-769-2295
  • Fax: 225-769-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number015955
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: