Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN116317 | LA |
NPI | 1184217770 |
---|---|
Provider Name | Mrs. Mandy Rae Carmouche |
First Address | Mandeville, LA 70448-4325 |
Second Address | New Orleans, LA 70118-5798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2021 |
Last Update Date | 16/02/2021 |