Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NOT REQUIRED IN LA |
NPI | 1093855009 |
---|---|
Provider Name | Mrs. Marion P Favre |
First Address | Slidell, LA 70458-4329 |
Second Address | Slidell, LA 70458-4329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 22/06/2015 |