Provider Demographics
NPI:1720650260
Name:PIPER, MICHEAL JAMAR
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:JAMAR
Last Name:PIPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 BENJAMIN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4001
Mailing Address - Country:US
Mailing Address - Phone:318-623-6201
Mailing Address - Fax:
Practice Address - Street 1:5010 BENJAMIN ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-4001
Practice Address - Country:US
Practice Address - Phone:318-623-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171WH0202X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No171WH0202XOther Service ProvidersContractorHome Modifications