Provider Demographics
NPI:1578330437
Name:SOLOMON, TAWANA
Entity Type:Individual
Prefix:MRS
First Name:TAWANA
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAWANA
Other - Middle Name:
Other - Last Name:MANUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5520 JOHNSTON ST STE K
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5138
Mailing Address - Country:US
Mailing Address - Phone:337-991-3800
Mailing Address - Fax:
Practice Address - Street 1:5520 JOHNSTON ST STE K
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5138
Practice Address - Country:US
Practice Address - Phone:337-991-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA310613246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy