Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD.204395 | LA |
NPI | 1003057076 |
---|---|
Provider Name | Dr. Jeanne Nicole Gautreaux |
First Address | Addis, LA 70710-3004 |
Second Address | Zachary, LA 70791-4092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2009 |
Last Update Date | 26/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1974722 | (05) | LA |