Provider Demographics
NPI:1023843992
Name:WASHINGTON, BILLIE
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 HISTORIC MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70051-3224
Mailing Address - Country:US
Mailing Address - Phone:985-817-9862
Mailing Address - Fax:
Practice Address - Street 1:470 HISTORIC MAIN ST
Practice Address - Street 2:
Practice Address - City:GARYVILLE
Practice Address - State:LA
Practice Address - Zip Code:70051-3224
Practice Address - Country:US
Practice Address - Phone:985-817-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company