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General NPI Number Information
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NPI Number | 1265629166
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Entity Type | Organization
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Legal Business Name | SEASONS HEALTHCARE OF MONROE, L.L.C.
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 1888 HUDSON CIRCLE SUITE 10
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-387-2828
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Fax | 318-387-2827
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Provider Business Mailing Address
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Address Line | 1888 HUDSON CIRCLE SUITE 10
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-387-2828
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Fax | 318-387-2827
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | NATHAN WAYNE GOODYEAR
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Credential | MD
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Telephone | 318-387-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RNO82557
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD.201086
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN075367
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License Number State | LA
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