Provider Demographics
NPI:1881977353
Name:BRAINTEASERS
Entity type:Organization
Organization Name:BRAINTEASERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:337-232-1166
Mailing Address - Street 1:858 KALISTE SALOOM RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4391
Mailing Address - Country:US
Mailing Address - Phone:337-232-1166
Mailing Address - Fax:
Practice Address - Street 1:858 KALISTE SALOOM RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4391
Practice Address - Country:US
Practice Address - Phone:337-232-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000OtherPRIVATE INSURANCE