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General NPI Number Information
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NPI Number | 1306089511
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Entity Type | Organization
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Legal Business Name | STERLINGTON VILLAGE LLC
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Dates
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Enumeration Date | 04/17/2009
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 10374 HIGHWAY 165 N STE D
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City | STERLINGTON
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State | LA
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Zip | 71280-3320
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Country | US
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Telephone | 318-812-2304
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Fax | 318-812-2306
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Provider Business Mailing Address
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Address Line | 10374 HIGHWAY 165 N STE D
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City | STERLINGTON
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State | LA
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Zip | 71280-3320
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Country | US
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Telephone | 318-812-2304
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Fax | 318-812-2306
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | NICOLE HOTARD
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Credential |
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Telephone | 318-812-2304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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