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General NPI Number Information
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NPI Number | 1609850270
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Entity Type | Organization
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Legal Business Name | LAKE ARTHUR HEALTH CLINIC LLC
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 328 KELLOGG AVE
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City | LAKE ARTHUR
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State | LA
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Zip | 70549-4116
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Country | US
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Telephone | 337-774-0100
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Fax | 337-774-0111
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Provider Business Mailing Address
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Address Line | PO BOX 765
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City | LAKE ARTHUR
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State | LA
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Zip | 70549-0765
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Country | US
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Telephone | 337-774-0100
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Fax | 337-774-0111
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TINA K MONLEZUN
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Credential | CFNP
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Telephone | 337-774-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APO2500
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License Number State | LA
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