Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | RT0004241 | LA |
NPI | 1104193176 |
---|---|
Provider Name | Letha Haynes |
First Address | New Orleans, LA 70125-1718 |
Second Address | La Place, LA 70068-8408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2011 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2138910 | (05) | LA |