=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649680091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDUSTRIAL OCCUPATIONAL SAFETY COUNCIL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2014
-----------------------------------------------------
Last Update Date | 05/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9305 MAIN ST STE E
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-7441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-570-8474
-----------------------------------------------------
Fax | 225-208-1035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9305 MAIN ST STE E
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-7441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-570-8474
-----------------------------------------------------
Fax | 225-208-1035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. SUNNY Q THIBODEAUX
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 225-570-8474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number | AP06891
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------