Healthcare Provider Details

I. General information

NPI: 1093048092
Provider Name (Legal Business Name): SONJA MICHELLE GIVENS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 NATCHITOCHES ST
WEST MONROE LA
71292-3751
US

IV. Provider business mailing address

1416 NATCHITOCHES ST
WEST MONROE LA
71292-3751
US

V. Phone/Fax

Practice location:
  • Phone: 318-362-5430
  • Fax: 318-362-5428
Mailing address:
  • Phone: 318-362-5430
  • Fax: 318-362-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number200075
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: