Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP08689 | LA |
NPI | 1073974150 |
---|---|
Provider Name | Jolie Ainsworth |
First Address | Alexandria, LA 71303-3709 |
Second Address | Alexandria, LA 71303-3709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2016 |
Last Update Date | 16/03/2016 |