Organization
SEASONS HEALTHCARE OF MONROE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN WAYNE GOODYEAR MD (MEDICAL DIRECTOR)
(318) 387-2828
Entity
Organization
Contact information
Practice address
1888 HUDSON CIRCLE, SUITE 10, MONROE, LA 71201
(318) 387-2828
(318) 387-2827
Mailing address
1888 HUDSON CIRCLE, SUITE 10, MONROE, LA 71201
(318) 387-2828
(318) 387-2827
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN075367
LA
163WG0000X
General Practice Registered Nurse
RNO82557
LA
207V00000X
Obstetrics & Gynecology Physician
MD.201086
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020455
PRESC ID
LA
01
—
1295731818
NPI
—
01
—
1538166970
NPI
—
01
—
1720054075
NPI
—
01
—
AP04115
APRN LICENSE
LA
01
—
APO4477
AP
LA
01
—
MD. 201086
STATE LICENSE
LA
01
—
RN075367
RN LICENSE
LA
01
—
RNO82557
RN
LA
Enumeration date
09/25/2007
Last updated
10/03/2007
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