Individual
MISS STEPHANIE ANN COGBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
4620 W CONGRESS ST APT 50, LAFAYETTE, LA 70506-6632
(337) 216-9354
Mailing address
4620 W CONGRESS ST APT 50, LAFAYETTE, LA 70506-6632
(337) 216-9354
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OTT.Z11937
LA
Other
Enumeration date
05/08/2008
Last updated
05/08/2008
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