Individual
MRS. ELLENDALE WITHERS GABBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C-FNP
Contact information
Practice address
501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 433-8400
(337) 312-6711
Mailing address
501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 312-8258
(337) 312-6711
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
63422-3267
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1557773
—
LA
Enumeration date
05/21/2007
Last updated
03/21/2017
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