Individual
THERESA TARVER BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1416 NATCHITOCHES ST, WEST MONROE, LA 71292-3751
(318) 362-5430
Mailing address
1416 NATCHITOCHES ST, WEST MONROE, LA 71292-3751
(318) 362-5430
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN032877
LA
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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