Individual
ANTOINETTE CHARLESTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
136 GREENWOOD DR, JENNINGS, LA 70546-4302
(337) 693-9445
Mailing address
136 GREENWOOD DR, JENNINGS, LA 70546-4302
(337) 693-9445
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12101972
PRIVATE
LA
Enumeration date
01/28/2019
Last updated
01/28/2019
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