Individual
LATASHA ANN BONNIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 HEYMANN BLVD, LAFAYETTE, LA 70503-2322
(337) 504-4279
Mailing address
106 HEYMANN BLVD, LAFAYETTE, LA 70503-2322
(337) 504-4279
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
270313
LA
Other
Enumeration date
03/29/2019
Last updated
03/29/2019
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