Healthcare Provider Details

I. General information

NPI: 1982692489
Provider Name (Legal Business Name): DONNA FOGLEMAN NELSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

474 HIGHWAY 866
WINNSBORO LA
71295-5562
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7714
  • Fax: 318-330-7715
Mailing address:
  • Phone: 318-435-6294
  • Fax: 318-330-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number604
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: