Individual
MARVETTA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
281 WEST 4TH STREET, INDEPENDENCE, LA 70443
(985) 878-0066
(985) 878-0969
Mailing address
18149 BRIARWOOD DR, HAMMOND, LA 70401-3740
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12365R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1697761
—
LA
Enumeration date
02/02/2007
Last updated
07/08/2007
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