Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 304973 | LA |
NPI | 1255774477 |
---|---|
Provider Name | Nour Khalid Abu Saleh |
First Address | Monroe, LA 71201-7257 |
Second Address | Monroe, LA 71201-7257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2013 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2439715 | (05) | LA |