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General NPI Number Information
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NPI Number | 1568822658
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Entity Type | Organization
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Legal Business Name | OVERTON BROOKS VAMC
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 200 HARTWELL RD
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City | MINDEN
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State | LA
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Zip | 71055-6365
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Country | US
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Telephone | 318-707-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HARTWELL ROAD
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City | MINDEN
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State | LA
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Zip | 71055
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Country | US
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Telephone | 318-707-5088
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Fax |
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Authorized Official
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Title or Position | ACUTE CARE NURSE PRACTITIONER
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Name | MRS. LAKISHIA LEWIS GRIDER
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Credential | N.P.
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Telephone | 318-221-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number | 006290999
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License Number State | LA
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