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General NPI Number Information
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NPI Number | 1851849525
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Entity Type | Organization
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Legal Business Name | NORTHSHORE PLASTIC SURGERY
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 3401 E CAUSEWAY APPROACH
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City | MANDEVILLE
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State | LA
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Zip | 70448-3447
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Country | US
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Telephone | 985-237-6050
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Fax | 985-237-6052
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Provider Business Mailing Address
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Address Line | 3401 E CAUSEWAY APPROACH
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City | MANDEVILLE
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State | LA
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Zip | 70448-3447
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Country | US
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Telephone | 985-237-6050
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Fax | 985-237-6052
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Authorized Official
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Title or Position | SURGICAL FIRST ASSIST
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Name | MS. LAUREN BRUMFIELD
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Credential | CST, CSFA
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Telephone | 985-517-6920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 164470
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License Number State | LA
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