Healthcare Provider Details

I. General information

NPI: 1043611585
Provider Name (Legal Business Name): VANICE ZENON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 MILLING AVE
LULING LA
70070-4442
US

IV. Provider business mailing address

2526 STANTON LN
SLIDELL LA
70460-3924
US

V. Phone/Fax

Practice location:
  • Phone: 504-575-3712
  • Fax: 504-575-3691
Mailing address:
  • Phone: 985-641-4061
  • Fax: 504-575-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7440
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: