Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 015955 | LA |
NPI | 1205892460 |
---|---|
Provider Name | Dr. Faith Hansbrough |
First Address | Baton Rouge, LA 70808 |
Second Address | Baton Rouge, LA 70809-3481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1367486 | (05) | LA |
B65076 | (02) |