Provider Demographics
NPI:1548049323
Name:FLEUR DE LIS LABS, LLC
Entity type:Organization
Organization Name:FLEUR DE LIS LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHONNA
Authorized Official - Middle Name:RAMIA
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPT, CCMA
Authorized Official - Phone:866-547-5227
Mailing Address - Street 1:753 ROBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1637
Mailing Address - Country:US
Mailing Address - Phone:866-547-5227
Mailing Address - Fax:985-217-1578
Practice Address - Street 1:753 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1637
Practice Address - Country:US
Practice Address - Phone:866-547-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory