Individual
CALLIE MICHELLE DETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1106 PORT ARTHUR TER, LEESVILLE, LA 71446-4643
(337) 404-4075
Mailing address
1840 VFW RD, LEESVILLE, LA 71446-6312
(337) 396-5829
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
330204
LA
Other
Enumeration date
02/28/2022
Last updated
03/02/2022
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