Healthcare Provider Details

I. General information

NPI: 1275295354
Provider Name (Legal Business Name): TOMMIE LACAZE NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 OLIVER RD # J
MONROE LA
71201-5702
US

IV. Provider business mailing address

130 DESIARD ST STE 355
MONROE LA
71201-7363
US

V. Phone/Fax

Practice location:
  • Phone: 318-807-3700
  • Fax: 318-807-0014
Mailing address:
  • Phone: 318-998-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number221897
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: