Healthcare Provider Details

I. General information

NPI: 1588048953
Provider Name (Legal Business Name): WINDSONG NATURAL THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 WEST KENTUCKY AVE
RUSTON LA
71270-9581
US

IV. Provider business mailing address

1742 WEST KENTUCKY AVE
RUSTON LA
71270-9581
US

V. Phone/Fax

Practice location:
  • Phone: 318-243-2231
  • Fax:
Mailing address:
  • Phone: 318-243-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLA0309
License Number StateLA

VIII. Authorized Official

Name: PAMELA LASTER
Title or Position: ACUPUNCTURE PHYSICIAN
Credential: L.AC
Phone: 318-243-2231