Individual
MARY VIRGINIA DISANTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
524 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5725
(337) 491-7700
Mailing address
2107 VENUS DR, BOSSIER CITY, LA 71112-4425
(318) 470-1339
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
RN056471
LA
Other
Enumeration date
12/18/2018
Last updated
12/18/2018
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