Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1285158121 |
---|---|
Provider Name | Evon Marie Lavergne |
First Address | Lake Charles, LA 70607-3634 |
Second Address | Lake Charles, LA 70607-3634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2017 |
Last Update Date | 02/08/2017 |