Provider Demographics
NPI:1306652961
Name:VINING, GUSTINA MARIE
Entity type:Individual
Prefix:
First Name:GUSTINA
Middle Name:MARIE
Last Name:VINING
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 1:456 HORSESHOE RD E
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-6978
Mailing Address - Country:US
Mailing Address - Phone:985-517-7858
Mailing Address - Fax:
Practice Address - Street 1:456 HORSESHOE RD E
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-6978
Practice Address - Country:US
Practice Address - Phone:985-517-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)