Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 202120 | LA |
NPI | 1003025347 |
---|---|
Provider Name | Anjanette L Varnado |
First Address | Greensburg, LA 70441 |
Second Address | Greensburg, LA 70441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 29/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1239321 | (05) | LA |