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General NPI Number Information
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NPI Number | 1366568800
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Entity Type | Organization
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Legal Business Name | THE MAGNOLIA CLINIC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 914 S POST OAK RD
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City | SULPHUR
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State | LA
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Zip | 70663-5246
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Country | US
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Telephone | 337-625-0035
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Fax | 337-625-0036
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Provider Business Mailing Address
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Address Line | 914 S POST OAK RD
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City | SULPHUR
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State | LA
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Zip | 70663-5246
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Country | US
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Telephone | 337-625-0035
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Fax | 337-625-0036
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SUSAN L DUHON
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Credential | CNP
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Telephone | 337-625-0035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | LA
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