Individual
MRS. CHARLOTTE MARTIA BORDELON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1516 CLOVER DR, LAKE CHARLES, LA 70607-4710
(337) 215-2613
(337) 990-5077
Mailing address
1516 CLOVER DR, LAKE CHARLES, LA 70607-4710
(337) 215-2613
(337) 990-5077
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
006828053
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-4215302
—
LA
Enumeration date
04/11/2018
Last updated
04/11/2018
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