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General NPI Number Information
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NPI Number | 1740643477
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Entity Type | Organization
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Legal Business Name | CHRISTUS HEALTH SWLA
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 1614 WOLF CIR
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City | LAKE CHARLES
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State | LA
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Zip | 70605-2348
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Country | US
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Telephone | 337-478-9653
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Fax |
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Provider Business Mailing Address
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Address Line | 1614 WOLF CIR
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City | LAKE CHARLES
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State | LA
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Zip | 70605-2348
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Country | US
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Telephone | 337-478-9653
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VERONICA DOUCETT
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Credential |
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Telephone | 337-478-9653
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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 | AP08587
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License Number State | LA
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