MEDICARE: AIMEE D DELAHOUSSAYE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP07220	LA

General Provider Information

NPI Number	:	1063753499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE D DELAHOUSSAYE FNP

Provider Business Mailing Address
First Line	:	823 N UNION ST
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-6313
Country	:	US
Telephone Number	:	337-678-3085
Fax Number	:	337-678-0627

Provider Business Practice Location Address
First Line	:	823 N UNION ST
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-6313
Country	:	US
Telephone Number	:	337-678-3085
Fax Number	:	337-678-0627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2013
Last Update Date	:	01/28/2014

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