Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP03293 | LA |
NPI | 1003882341 |
---|---|
Provider Name | Arris Slocum Brunet |
First Address | Lacombe, LA 70445 |
Second Address | Lacombe, LA 70445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 30/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1563994 | (05) | LA |