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General NPI Number Information
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NPI Number | 1265769798
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Entity Type | Individual
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Provider Name | MARIEL J RACCA NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 04/02/2013
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Provider Practice Location Address
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Address Line | 2000 OPELOUSAS ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-2641
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Country | US
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Telephone | 337-493-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 STANTON ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7212
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Country | US
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Telephone | 337-433-8113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | F1009130
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License Number State | LA
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