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NPI Profile for JUSTIN BOHANNAN in LAKE CHARLES, LA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Acute Care |
363LA2100X | 50 | Nurse Practitioner |
| NPI # | 1124695408 |
|
| Status | Active | |
| Credentials | AG-ACNP | |
| Entity | Individual | |
| Enumeration date | 06/07/2021 | |
| Last updated | 02/03/2022 - About 4 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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JUSTIN BOHANNAN
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JUSTIN BOHANNAN, AG-ACNP