Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP06592 | LA |
NPI | 1093087298 |
---|---|
Provider Name | Mrs. Carmie Anita Beshea |
First Address | Bossier City, LA 71111-2224 |
Second Address | Shreveport, LA 71103-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 02/02/2012 |