Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN058633 | LA |
NPI | 1043292139 |
---|---|
Provider Name | Mrs. Melanie Tharp |
First Address | Alexandria, LA 71303-2068 |
Second Address | Alexandria, LA 71301-8124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S37687 | (02) | LA |