| NPI | 1639617103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALIE DEMOSS Member 318-512-4112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: LA AP08400) |
| Enumeration Date | 2017-02-05 |
| Last Update Date | 2017-04-21 |