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NPI Code Detail

MEDICARE: ARETHA FUDGE

MEDICARE: ARETHA FUDGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1372500000XChore Provider372500000XLA
2372600000XAdult Companion372600000XLA
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1730572371
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARETHA FUDGE
Provider Business Mailing Address
First Line : 805 STUBBS AVE STE A
Second Line :
City : MONROE
State : LA
Zip : 71201-5579
Country : US
Telephone Number : 318-614-4455
Fax Number :
Provider Business Practice Location Address
First Line : 506 HIGHWAY 2
Second Line :
City : STERLINGTON
State : LA
Zip : 71280-3004
Country : US
Telephone Number : 318-598-5040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2015
Last Update Date : 11/09/2018

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Directions to “ ARETHA FUDGE ” Practice Location

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