Individual
JUDI MICKENHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2106 AVENUE F, BOGALUSA, LA 70427-5027
(985) 732-6655
(985) 732-6678
Mailing address
2106 AVENUE F, BOGALUSA, LA 70427-5027
(985) 732-6655
(985) 732-6678
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
034729
LA
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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