Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN033751-AP02182 | LA |
NPI | 1003961830 |
---|---|
Provider Name | Ms. Diane Marie Badeaux |
First Address | Raceland, LA 70394 |
Second Address | Galliano, LA 70354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1435091 | (05) | LA |