Healthcare Provider Details

I. General information

NPI: 1184099897
Provider Name (Legal Business Name): RESA BRADY BC-HIS, COHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MCMILLAN RD
WEST MONROE LA
71291-5353
US

IV. Provider business mailing address

105 MCMILLAN RD
WEST MONROE LA
71291-5353
US

V. Phone/Fax

Practice location:
  • Phone: 318-605-3321
  • Fax: 318-605-4576
Mailing address:
  • Phone: 318-605-3321
  • Fax: 318-605-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number806
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: