Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 4324 | LA |
NPI | 1396254090 |
---|---|
Provider Name | Kevin Rostetter |
First Address | Saint Rose, LA 70087-3670 |
Second Address | Kenner, LA 70065-2467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 25/09/2017 |