Provider Demographics
NPI:1235627266
Name:MANUEL, LORI MILLER (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MILLER
Last Name:MANUEL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MACARTHUR DR
Mailing Address - Street 2:POST OFFICE BOX 236
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-6212
Mailing Address - Country:US
Mailing Address - Phone:337-662-3737
Mailing Address - Fax:337-662-3636
Practice Address - Street 1:311 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6212
Practice Address - Country:US
Practice Address - Phone:337-662-3737
Practice Address - Fax:337-662-3636
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN071837163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA800382652Medicaid