Healthcare Provider Details

I. General information

NPI: 1417287939
Provider Name (Legal Business Name): MRS. SHAUNTEL RENEE CEASAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9236 BARN STABLE DR
LAKE CHARLES LA
70607-0893
US

IV. Provider business mailing address

PO BOX 959
LAKE CHARLES LA
70602-0959
US

V. Phone/Fax

Practice location:
  • Phone: 337-377-3627
  • Fax: 337-439-2120
Mailing address:
  • Phone: 337-377-3627
  • Fax: 337-439-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: