Healthcare Provider Details

I. General information

NPI: 1881803625
Provider Name (Legal Business Name): ALLISON CORMIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 CANE DR
LAFAYETTE LA
70508-4339
US

IV. Provider business mailing address

512 CANE DR
LAFAYETTE LA
70508-4339
US

V. Phone/Fax

Practice location:
  • Phone: 337-278-3038
  • Fax: 337-231-5546
Mailing address:
  • Phone: 337-278-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number4349
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberLEVEL 2 439834
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: