Individual
MANDRELL MONTEL JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
646 S GAYOSO ST, NEW ORLEANS, LA 70119-7249
(504) 666-2016
Mailing address
646 S GAYOSO ST, NEW ORLEANS, LA 70119-7249
(504) 666-2016
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
300248
LA
Other
Enumeration date
11/02/2024
Last updated
11/02/2024
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