Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 221576 | LA |
NPI | 1023789328 |
---|---|
Provider Name | Mrs. Christina Miller Bates |
First Address | Deridder, LA 70634-2294 |
Second Address | Deridder, LA 70634-4856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2021 |
Last Update Date | 26/09/2021 |