Individual
JULIA SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17412 LAKE VISTA DR, GREENWELL SPRINGS, LA 70739-4757
(225) 907-8843
Mailing address
17412 LAKE VISTA DR, GREENWELL SPRINGS, LA 70739-4757
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
LA
Enumeration date
11/17/2021
Last updated
11/17/2021
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