Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP05955 | LA |
NPI | 1013242825 |
---|---|
Provider Name | Ms. Anne Borne Colwart |
First Address | Thibodaux, LA 70301-6240 |
Second Address | Destrehan, LA 70047-5076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2009 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02009040 | (05) | MS |
2379569 | (05) | LA |
3B477 | (02) | LA |