Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP09202 | LA |
NPI | 1043732894 |
---|---|
Provider Name | Mrs. Ilea Nauts |
First Address | Lake Charles, LA 70605-4041 |
Second Address | Lake Charles, LA 70601-8911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2017 |
Last Update Date | 05/03/2018 |