1932359635 NPI number — MS. SHAINA CELESTE ELLIOTT R.D.

Table of content: MS. SHAINA CELESTE ELLIOTT R.D. (NPI 1932359635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932359635 NPI number — MS. SHAINA CELESTE ELLIOTT R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
SHAINA
Provider Middle Name:
CELESTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932359635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 JERRY ROAD
Provider Second Line Business Mailing Address:
P.O. BOX 287
Provider Business Mailing Address City Name:
LACASSINE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-588-4941
Provider Business Mailing Address Fax Number:
337-588-4941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 OAK PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-494-6425
Provider Business Practice Location Address Fax Number:
337-430-6959
Provider Enumeration Date:
09/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1675 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com