Individual
MRS. MARY LOUISE TALBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 LAKE SHORE DR, STE. 522, LAKE CHARLES, LA 70601-9412
(337) 439-2119
(337) 439-2120
Mailing address
PO BOX 580, LAKE CHARLES, LA 70602-0580
(337) 439-2119
(337) 439-2120
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2921-302-571
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2921-302-571
NATIONAL CERT. COD. SPEC.
LA
Enumeration date
07/06/2006
Last updated
07/08/2007
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