Organization
ISLAND SIDE HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA PENA MILLER APRN (NURSE PRACTITIONER)
(337) 326-0202
Entity
Organization
Contact information
Practice address
414 WOODVALE AVE, LAFAYETTE, LA 70503-3434
(337) 326-0202
Mailing address
414 WOODVALE AVE, LAFAYETTE, LA 70503-3434
(337) 326-0202
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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