Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | LA3426 | LA |
NPI | 1245520782 |
---|---|
Provider Name | Jann Corley |
First Address | Lake Charles, LA 70605-2645 |
Second Address | Lake Charles, LA 70605-2645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 18/04/2011 |