Provider Demographics
NPI:1417464017
Name:LITTLE TOES BUTTON NOSE
Entity type:Organization
Organization Name:LITTLE TOES BUTTON NOSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIKA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-304-6247
Mailing Address - Street 1:247 W SALLIER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5843
Mailing Address - Country:US
Mailing Address - Phone:337-602-6004
Mailing Address - Fax:337-602-6037
Practice Address - Street 1:247 W SALLIER ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5843
Practice Address - Country:US
Practice Address - Phone:337-602-6004
Practice Address - Fax:337-602-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty