Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN100329 | LA |
NPI | 1225354632 |
---|---|
Provider Name | Amanda Carnes |
First Address | Monroe, LA 71210-1901 |
Second Address | Monroe, LA 71201-7407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 09/04/2010 |