| NPI | 1770007684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FALLON ALIESHA FUNDERBURK Registered Nurse First Assistant 318-218-0515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: LA RN105855) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2017-08-01 |