Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP04114 | LA |
NPI | 1144243700 |
---|---|
Provider Name | Mr. Scott Paul Landry |
First Address | Hammond, LA 70404-2668 |
Second Address | Hammond, LA 70403-1434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 25/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1193445 | (05) | LA |