Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN065304 APO1230 | LA |
NPI | 1033109038 |
---|---|
Provider Name | Deeanna Bennett Beaver |
First Address | Theriot, LA 70397 |
Second Address | Houma, LA 70360-4154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 19/09/2017 |