1316796485 NPI number — MRS. MOUNIRA AIMEE SWAFFORD PLPC

Table of content: MRS. MOUNIRA AIMEE SWAFFORD PLPC (NPI 1316796485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316796485 NPI number — MRS. MOUNIRA AIMEE SWAFFORD PLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAFFORD
Provider First Name:
MOUNIRA
Provider Middle Name:
AIMEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEPHENS
Provider Other First Name:
MOUNIRA
Provider Other Middle Name:
AIMEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316796485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 580
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETH
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70638-0580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-215-6051
Provider Business Mailing Address Fax Number:
318-634-5218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 LIVE OAK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-208-2148
Provider Business Practice Location Address Fax Number:
318-634-5218
Provider Enumeration Date:
05/13/2024

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: 101YS0200X , with the licence number:  PLC8496 , 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)





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