Healthcare Provider Details

I. General information

NPI: 1467558627
Provider Name (Legal Business Name): LORRA M. PETTIT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 BROADMOOR BLVD
MONROE LA
71201-2988
US

IV. Provider business mailing address

130 DESIARD STREET SUITE 355
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-812-1125
  • Fax:
Mailing address:
  • Phone: 318-807-7875
  • Fax: 318-410-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3110
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: