Organization
REVISION INK LLC
Active
Other names
Revision Ink
Organization subpart
No
Provider details
NPI number
Authorized official
AMAINTE B GODEAUX (OWNER/OPERATOR)
(337) 945-0631
Entity
Organization
Contact information
Practice address
1007 BERTRAND PKWY, BROUSSARD, LA 70518-8025
(337) 945-0631
Mailing address
615 EASY ROCK LANDING DR, BROUSSARD, LA 70518-7775
(337) 945-0631
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
Primary
—
—
Other
Enumeration date
04/14/2021
Last updated
04/14/2021
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