Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1871920116 |
---|---|
Provider Name | Mr. Randy Melerine |
First Address | Kenner, LA 70065-7700 |
Second Address | Kenner, LA 70065-7700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2013 |
Last Update Date | 16/06/2016 |