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General NPI Number Information
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NPI Number | 1184215568
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Entity Type | Organization
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Legal Business Name | SDV HEALTHCARE LLC
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Dates
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Enumeration Date | 01/28/2021
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 3024 WESTFORK DR STE B
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City | BATON ROUGE
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State | LA
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Zip | 70816-2252
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Country | US
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Telephone | 225-229-3254
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Fax |
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Provider Business Mailing Address
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Address Line | 4520 S. SHERWOOD FOREST SUITE 104 #389
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City | BATON ROUGE
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State | LA
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Zip | 70816
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Country | US
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Telephone | 225-229-3254
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MRS. DAWN MELANCON
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Credential | NP
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Telephone | 225-301-2982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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