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General NPI Number Information
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NPI Number | 1497815815
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Entity Type | Organization
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Legal Business Name | OPH-REGION 4-NURSE-FAMILY PARTNERSHIP PROGRAM
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 825 KALISTE SALOOM RD BRANDYWINE III, SUITE 100
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City | LAFAYETTE
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State | LA
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Zip | 70508-4284
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Country | US
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Telephone | 337-262-5319
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Fax | 337-262-5237
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Provider Business Mailing Address
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Address Line | 825 KALISTE SALOOM RD BRANDYWINE III, SUITE 100
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City | LAFAYETTE
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State | LA
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Zip | 70508-4284
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Country | US
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Telephone | 337-262-5319
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Fax | 337-262-5237
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Authorized Official
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Title or Position | REGION 4-NFP SUPERVISOR-PHN-5
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Name | PATRICIA MCNEILL
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Credential | BSN, RN
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Telephone | 337-262-5319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CM 9912
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License Number State | LA
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