Provider Demographics
NPI:1053686451
Name:PRIMEAUX, BRENDA J (CLS-G)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:J
Last Name:PRIMEAUX
Suffix:
Gender:F
Credentials:CLS-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1452
Mailing Address - Street 2:18399 JOHNNY B HALL MEMORIAL HWY
Mailing Address - City:ROSEPINE
Mailing Address - State:LA
Mailing Address - Zip Code:70659
Mailing Address - Country:US
Mailing Address - Phone:337-463-7535
Mailing Address - Fax:337-202-1897
Practice Address - Street 1:18399 JOHNNY B HALL MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ROSEPINE
Practice Address - State:LA
Practice Address - Zip Code:70659
Practice Address - Country:US
Practice Address - Phone:337-463-7535
Practice Address - Fax:337-202-1897
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACLP.G00723-GEN246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other