Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | CLP.204288-SPE | LA |
NPI | 1013387620 |
---|---|
Provider Name | Dr. Mary Catherine Phelan IV |
First Address | New Orleans, LA 70112-2632 |
Second Address | New Orleans, LA 70112-2632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2015 |
Last Update Date | 25/09/2015 |