Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP07708 | LA |
NPI | 1003227513 |
---|---|
Provider Name | Mrs. Alison T. Cantrall |
First Address | Lafayette, LA 70508-8800 |
Second Address | New Iberia, LA 70560-4046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 19/05/2014 |