Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP04543 | LA |
N | 363LC1500X | Nurse Practitioner - Community Health | AP04543 | LA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95003863 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP04543 | LA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95003863 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP04543 | LA |
NPI | 1679766455 |
---|---|
Provider Name | Mrs. Mary Amelia Duncan |
First Address | Mamou, LA 70554 |
Second Address | Mamou, LA 70554-2224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 03/11/2017 |