Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN033348 | LA |
NPI | 1013048438 |
---|---|
Provider Name | Ms. Linda L Chevallier |
First Address | Lake Charles, LA 70607 |
Second Address | Lake Charles, LA 70607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1666963 | (05) | LA |
S02754 | (02) | LA |