Healthcare Provider Details

I. General information

NPI: 1740636430
Provider Name (Legal Business Name): CATHERINE LORRAINE WEAVER LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 GAUSE BLVD E
SLIDELL LA
70461-4243
US

IV. Provider business mailing address

2132 GAUSE BLVD E STE 6
SLIDELL LA
70461-4243
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-2531
  • Fax: 985-649-1391
Mailing address:
  • Phone: 985-646-2531
  • Fax: 985-649-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number301785
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: