Individual
TINA BAZILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
900 WILKINSON ST, MANDEVILLE, LA 70448-3533
(985) 624-4450
(985) 624-4461
Mailing address
900 WILKINSON ST, MANDEVILLE, LA 70448-3533
(985) 624-4450
(985) 624-4461
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
240617
LA
Other
Enumeration date
04/12/2013
Last updated
04/12/2013
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