Provider Demographics
NPI:1144847211
Name:PELICAN MOBILE HEALTH, LLC
Entity type:Organization
Organization Name:PELICAN MOBILE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAR
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:318-381-3595
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:STERLINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:71280-1088
Mailing Address - Country:US
Mailing Address - Phone:318-381-3595
Mailing Address - Fax:
Practice Address - Street 1:105 AYCOCK RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-9335
Practice Address - Country:US
Practice Address - Phone:318-381-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty