Organization
NORTHSHORE ENT CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY R. MELLIN M.D. (OWNER)
(985) 542-9155
Entity
Organization
Contact information
Practice address
42401 PELICAN PROFESSIONAL PARK, HAMMOND, LA 70403-2405
(985) 542-9155
(985) 542-9133
Mailing address
42401 PELICAN PROFESSIONAL PARK, HAMMOND, LA 70403-2405
(985) 542-9155
(985) 542-9133
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1449407
—
LA
Enumeration date
07/19/2005
Last updated
03/14/2008
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