Individual
LISA BOUDREAUX MIMNAGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
151 GAINESVILLE DR, GRAY, LA 70359-4525
(985) 790-2568
Mailing address
151 GAINESVILLE DR, GRAY, LA 70359-4525
(985) 790-2568
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP09186
LA
Other
Enumeration date
02/08/2017
Last updated
02/08/2017
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