Provider Information for 1003589441
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LORI LANDRY REEVES
Sex: Female
NPI: 1003589441
Last Updated: 2021-07-30
Certification Date: 2021-07-30
Certification Date: 2021-07-30
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1003589441 | ||||||||
| Enumeration Date | 2021-07-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 104 TASVO TRL LAFAYETTE, LA 70508-8171 United States Phone: 858-229-1629 | Fax: | ||||||||
| Primary Practice Address | 104 TASVO TRL LAFAYETTE, LA 70508-8171 United States Phone: 858-229-1629 | Fax: | ||||||||
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