Healthcare Provider Details

I. General information

NPI: 1245611953
Provider Name (Legal Business Name): COURTNEY COMMANDER AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR STE 301
HAMMOND LA
70403-1431
US

IV. Provider business mailing address

PO BOX 3087
HAMMOND LA
70404-3087
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2630
  • Fax: 985-230-2634
Mailing address:
  • Phone: 985-230-3653
  • Fax: 985-370-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number7358
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: