Individual
AUTAINIA SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 LOUISIANA AVE, BOGALUSA, LA 70427-3839
(888) 417-5250
Mailing address
106 BUSINESS PARK AVENUE, DENHAM SPRINGS, LA 70726
(888) 417-5250
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
LA
Enumeration date
05/04/2018
Last updated
12/05/2018
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