Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor |
NPI | 1144800715 |
---|---|
Provider Name | Miss Jatauria Deparis Shardaye Dean |
First Address | Ruston, LA 71270-3180 |
Second Address | Monroe, LA 71202-2030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2021 |
Last Update Date | 08/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1457731366 | (05) | LA |