Individual
GLADYS DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2411 ERNEST ST, LAKE CHARLES, LA 70601-7265
(337) 292-1625
Mailing address
2411 ERNEST ST, LAKE CHARLES, LA 70601-7265
(337) 292-1625
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
270606
LA
Other
Enumeration date
02/23/2019
Last updated
02/23/2019
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