Organization
ETERNITY HEALTH CARE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NONA MARIE LEDAY BRYANT CNS (OWNER)
(337) 439-4220
Entity
Organization
Contact information
Practice address
1432 FOURNET ST, LAKE CHARLES, LA 70601-2452
(337) 439-4220
(337) 439-6351
Mailing address
PO BOX 1962, LAKE CHARLES, LA 70602-1962
(337) 439-4220
(337) 439-6351
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
RN050908 AP03651
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1106798
—
LA
Enumeration date
06/21/2006
Last updated
08/22/2020
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