Individual
TAMMY ROXANNE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
626 CAROLINA AVE, BOGALUSA, LA 70427-3319
(985) 732-6615
(985) 732-6621
Mailing address
221 PEA RIDGE RD, PICAYUNE, MS 39466-7824
(601) 347-2643
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN078048
LA
Other
Enumeration date
06/18/2012
Last updated
06/18/2012
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