| NPI | 1487066296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH A HATHORN Office Manager 318-686-8197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 011400) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA ap06110) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2014-05-28 |