Provider Demographics
NPI:1447485412
Name:LOUISIANA INCONCTINENCE CONSULTANTS
Entity type:Organization
Organization Name:LOUISIANA INCONCTINENCE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:DUOS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-349-4836
Mailing Address - Street 1:2200 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-7462
Mailing Address - Country:US
Mailing Address - Phone:337-349-4836
Mailing Address - Fax:337-506-2010
Practice Address - Street 1:2200 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-7462
Practice Address - Country:US
Practice Address - Phone:337-349-4836
Practice Address - Fax:337-506-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05285363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty