Provider Demographics
NPI:1447597703
Name:DRUMMER, CONNIE M
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:DRUMMER
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:MOREAUVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71355-0001
Mailing Address - Country:US
Mailing Address - Phone:318-985-2004
Mailing Address - Fax:318-985-2112
Practice Address - Street 1:377 PORTER LN.
Practice Address - Street 2:
Practice Address - City:MOREAUVILLE
Practice Address - State:LA
Practice Address - Zip Code:71355
Practice Address - Country:US
Practice Address - Phone:318-985-2004
Practice Address - Fax:318-985-2112
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADME.000318332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies