Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN081153 -AP05151 | LA |
NPI | 1013045624 |
---|---|
Provider Name | Marshall Quinn Coco |
First Address | Lafayette, LA 70506-5939 |
Second Address | Lafayette, LA 70506-5904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 09/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1008176 | (05) | LA |
Q77192 | (02) | LA |