Healthcare Provider Details

I. General information

NPI: 1447636626
Provider Name (Legal Business Name): NATHALY CARRION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PAUL MAILLARD RD
LULING LA
70070-4349
US

IV. Provider business mailing address

416 DOUCET RD UNIT 7F
LAFAYETTE LA
70503-3466
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-3655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08455
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: