Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP09156 | LA |
NPI | 1366946980 |
---|---|
Provider Name | Marie Bulliard Hanks |
First Address | Lafayette, LA 70503-2621 |
Second Address | Lafayette, LA 70503-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 19/03/2018 |