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General NPI Number Information
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NPI Number | 1144495334
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Entity Type | Organization
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Legal Business Name | ACUTE CARE CLINIC
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 205 HERMITAGE DR
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City | THIBODAUX
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State | LA
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Zip | 70301-2914
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Country | US
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Telephone | 985-448-0827
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Fax | 985-448-0822
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Provider Business Mailing Address
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Address Line | 1208 CANAL BLVD
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City | THIBODAUX
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State | LA
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Zip | 70301-4511
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Country | US
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Telephone | 985-448-0827
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Fax | 985-448-0822
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. AYANNA A ALVEREZ
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Credential |
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Telephone | 504-382-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number | MD06503R
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License Number State | LA
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