Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP03986 | LA |
NPI | 1013189125 |
---|---|
Provider Name | Mrs. Jeanne Bienvenu Dakin |
First Address | Slidell, LA 70460-2325 |
Second Address | Slidell, LA 70461-5520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2008 |
Last Update Date | 28/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1142620 | (05) | LA |