Individual
MIESHAN MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4700 WICHERS DR STE 2-5, MARRERO, LA 70072-3041
(504) 407-0709
Mailing address
1541 HANGING MOSS LN, GRETNA, LA 70056-7794
(504) 307-1100
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/25/2016
Last updated
01/25/2016
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