Provider Demographics
NPI:1093366072
Name:TRAHAN, BONNIE D
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:D
Last Name:TRAHAN
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 1:11833 LA HWY 35
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-6646
Mailing Address - Country:US
Mailing Address - Phone:337-643-2085
Mailing Address - Fax:
Practice Address - Street 1:11833 LA HWY 35
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-6646
Practice Address - Country:US
Practice Address - Phone:337-517-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
LANONEOtherTRICARE