Individual
TANIECIA CALLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
420 MAGNOLIA ST, HOUMA, LA 70360-6304
(985) 879-3966
Mailing address
420 MAGNOLIA ST, HOUMA, LA 70360-6304
(985) 879-3966
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20170578
LA
Other
Enumeration date
11/09/2017
Last updated
11/09/2017
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