Individual
EBONY PAIGE MENARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
106 HEYMANN BLVD, LAFAYETTE, LA 70503-2322
(337) 366-5370
Mailing address
604 DEER MEADOW BLVD, BROUSSARD, LA 70518-5232
(337) 366-5370
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20130925
LA
Other
Enumeration date
01/11/2023
Last updated
01/11/2023
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