Healthcare Provider Details

I. General information

NPI: 1144701418
Provider Name (Legal Business Name): DEBORAH HUVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OAK PARK BLVD
LAKE CHARLES LA
70601-7864
US

IV. Provider business mailing address

2100 OAK PARK BLVD
LAKE CHARLES LA
70601-7864
US

V. Phone/Fax

Practice location:
  • Phone: 337-475-0324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN126260
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: