Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MDW.200011 | LA |
NPI | 1164834438 |
---|---|
Provider Name | Mrs. Michel Richard Martien |
First Address | Broussard, LA 70518-5322 |
Second Address | Broussard, LA 70518-5322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 21/05/2014 |