Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP05266 | LA |
NPI | 1023202207 |
---|---|
Provider Name | Mrs. Heather Renee Rachal |
First Address | Alexandria, LA 71301-2827 |
Second Address | Alexandria, LA 71301-8124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 30/08/2007 |