Healthcare Provider Details

I. General information

NPI: 1821233719
Provider Name (Legal Business Name): MS. LARHONDA CARNELL MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 PECAN ST
MONROE LA
71202-2950
US

IV. Provider business mailing address

1406 PECAN ST
MONROE LA
71202-2950
US

V. Phone/Fax

Practice location:
  • Phone: 318-398-7160
  • Fax:
Mailing address:
  • Phone: 318-398-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: