Healthcare Provider Details

I. General information

NPI: 1194216465
Provider Name (Legal Business Name): SHANNE GILBERT RPT,RMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WESTMARK BLVD STE 2A
LAFAYETTE LA
70506-7344
US

IV. Provider business mailing address

1 GALLERIA BLVD STE 1900
METAIRIE LA
70001-7553
US

V. Phone/Fax

Practice location:
  • Phone: 504-656-4071
  • Fax:
Mailing address:
  • Phone: 337-595-5116
  • Fax: 800-541-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: