1235895939 NPI number — MS. TONETTE MARIE MABREY LMT LA 9071

Table of content: MS. TONETTE MARIE MABREY LMT LA 9071 (NPI 1235895939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235895939 NPI number — MS. TONETTE MARIE MABREY LMT LA 9071

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MABREY
Provider First Name:
TONETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT LA 9071
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MABREY
Provider Other First Name:
TONETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT LA 9071
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235895939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
64533 BIRCH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL RIVER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70452-5017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-356-7619
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64533 BIRCH COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL RIVER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  LA9071 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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