Individual
MICHELE EWING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 MARINERS PLAZA DR STE 603, MANDEVILLE, LA 70448-6826
(985) 465-4250
Mailing address
2626 8TH ST, SLIDELL, LA 70458-3808
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
721469692
—
LA
Enumeration date
04/19/2017
Last updated
04/19/2017
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