Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | APO4946 | LA |
NPI | 1003900564 |
---|---|
Provider Name | Tamara J Trainer |
First Address | Shreveport, LA 71101 |
Second Address | Shreveport, LA 71101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 24/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1507105 | (05) | LA |
Q72429 | (02) | LA |