Provider Demographics
NPI:1255902656
Name:PILLARD, ENOLA
Entity type:Individual
Prefix:
First Name:ENOLA
Middle Name:
Last Name:PILLARD
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 1:2304 E PINHOOK RD STE E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-3917
Mailing Address - Country:US
Mailing Address - Phone:337-780-1868
Mailing Address - Fax:
Practice Address - Street 1:2304 E PINHOOK RD STE E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3917
Practice Address - Country:US
Practice Address - Phone:337-780-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA999356371744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management