Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RS0012X | Sleep Medicine | POLY000271 | LA |
NPI | 1376176768 |
---|---|
Provider Name | Carolyn Benoit |
First Address | Rayne, LA 70578-4546 |
Second Address | Rayne, LA 70578-4546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2020 |
Last Update Date | 13/02/2020 |