Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 204336 | LA |
NPI | 1063046662 |
---|---|
Provider Name | Courtney Lynn Thomas |
First Address | Lake Charles, LA 70605-7128 |
Second Address | Lake Charles, LA 70605-7170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2020 |
Last Update Date | 24/02/2020 |