Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP05179 | LA |
NPI | 1003356437 |
---|---|
Provider Name | Charlotte Radde |
First Address | Sulphur, LA 70665-7724 |
Second Address | Lake Charles, LA 70605-7170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2017 |
Last Update Date | 05/03/2017 |