Healthcare Provider Details

I. General information

NPI: 1962536235
Provider Name (Legal Business Name): LA DUSTA KATHERINE SONNIER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5426 BASILE EUNICE HWY
EUNICE LA
70535
US

IV. Provider business mailing address

5426 BASILE EUNICE HWY
EUNICE LA
70535-7017
US

V. Phone/Fax

Practice location:
  • Phone: 337-550-8572
  • Fax:
Mailing address:
  • Phone: 337-550-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1462-01
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: