Healthcare Provider Details

I. General information

NPI: 1386313500
Provider Name (Legal Business Name): CHRISTINE DESIREE MARBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17246 MILTON DR
FRENCH SETTLEMENT LA
70733-2419
US

IV. Provider business mailing address

17246 MILTON DR
FRENCH SETTLEMENT LA
70733-2419
US

V. Phone/Fax

Practice location:
  • Phone: 225-505-5847
  • Fax:
Mailing address:
  • Phone: 225-505-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number20160761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: