| NPI | 1700827219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J. GAVIN Network Administrator 318-212-8780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-11-08 |