Provider Demographics
NPI:1073299756
Name:MCGOWAN, LAKESHA MARIE
Entity Type:Individual
Prefix:
First Name:LAKESHA
Middle Name:MARIE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 W NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2249
Mailing Address - Country:US
Mailing Address - Phone:504-358-8443
Mailing Address - Fax:
Practice Address - Street 1:4955 W NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2249
Practice Address - Country:US
Practice Address - Phone:504-358-8443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007021994172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver