Basic Information
| Provider Information | |||||||||
| NPI: | 1760504799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST.CYR | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | SCHUPBACH | ||||||||
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| Credential: | R.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3642 ALLENE ST | ||||||||
| Address2: | |||||||||
| City: | BRUSLY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707192085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257497660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8080 BLUEBONNET BLVD | ||||||||
| Address2: | 1000 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708107827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259242424 | ||||||||
| FaxNumber: | 2254087929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3402X | 7009 | LA | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography |
No ID Information.