| NPI | 1033617071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICA MCDANIEL Owner / Authorized Official 318-308-4447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA RN088334) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-05-17 |