Provider Demographics
NPI:1992172621
Name:FAMILY HEALTHCARE OF LORANGER, LLC
Entity type:Organization
Organization Name:FAMILY HEALTHCARE OF LORANGER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MANINA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:985-606-2273
Mailing Address - Street 1:54033 HIGHWAY 1062, SUITE B
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446
Mailing Address - Country:US
Mailing Address - Phone:985-606-2273
Mailing Address - Fax:985-606-2268
Practice Address - Street 1:54033 HIGHWAY 1062, SUITE B
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446
Practice Address - Country:US
Practice Address - Phone:985-606-2273
Practice Address - Fax:985-606-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06729261QP2300X, 261QR1300X
LAAP6729364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty