Healthcare Provider Details

I. General information

NPI: 1578330437
Provider Name (Legal Business Name): MRS. TAWANA SOLOMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. TAWANA MANUEL

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 JOHNSTON ST STE K
LAFAYETTE LA
70503-5138
US

IV. Provider business mailing address

5520 JOHNSTON ST STE K
LAFAYETTE LA
70503-5138
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-3800
  • Fax:
Mailing address:
  • Phone: 337-991-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number310613
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: