1053672691 NPI number — PAMELA ANN POURCIAU

Table of content: PAMELA ANN POURCIAU (NPI 1053672691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053672691 NPI number — PAMELA ANN POURCIAU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POURCIAU
Provider First Name:
PAMELA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053672691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 RUE DE SANTE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
LA PLACE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70068-5424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-653-9675
Provider Business Mailing Address Fax Number:
985-652-7893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 RUE DE SANTE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068-5424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-653-9675
Provider Business Practice Location Address Fax Number:
985-652-7893
Provider Enumeration Date:
05/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  APO6794 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA ID # 010306 . This is a "LA STATE BOARD OF NURSING PRESCRIPTIVE AND DISTRIBUTING IDENTIFICATION NUMER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: A0312016 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION #" identifier . This identifiers is of the category "OTHER".
  • Identifier: APO 6794 . This is a "ADVANCED PRACTICE NURSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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