Provider Demographics
NPI:1417126277
Name:MUNSON-WHETSTONE, VICKI ZEMINA (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ZEMINA
Last Name:MUNSON-WHETSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VICKI
Other - Middle Name:ZEMINA
Other - Last Name:MUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4242 HIGHWAY 19
Mailing Address - Street 2:SUITE C
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3981
Mailing Address - Country:US
Mailing Address - Phone:225-286-8100
Mailing Address - Fax:225-286-8110
Practice Address - Street 1:4242 HIGHWAY 19
Practice Address - Street 2:SUITE C
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3981
Practice Address - Country:US
Practice Address - Phone:225-286-8100
Practice Address - Fax:225-286-8110
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1077933Medicaid