Individual
MIA ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
39646 TEEL RD, PONCHATOULA, LA 70454-4512
(985) 640-5722
Mailing address
39646 TEEL RD, PONCHATOULA, LA 70454-4512
(985) 640-5722
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
214467
LA
Other
Enumeration date
06/18/2025
Last updated
06/18/2025
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