Individual
MARIEL J RACCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2000 OPELOUSAS ST, LAKE CHARLES, LA 70601-2641
(337) 493-5115
Mailing address
2110 STANTON ST, LAKE CHARLES, LA 70601-7212
(337) 433-8113
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F1009130
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265769798
—
LA
Enumeration date
11/04/2009
Last updated
04/02/2013
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