MEDICARE: MS. HOLLAN DESHOTEL FORTIER APRN, FNP-C

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	AP07698	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336564533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLAN DESHOTEL FORTIER APRN, FNP-C

Provider Business Mailing Address
First Line	:	401 YOUNGSVILLE HWY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5173
Country	:	US
Telephone Number	:	337-330-0031
Fax Number	:	337-330-0059

Provider Business Practice Location Address
First Line	:	1119 N MAIN ST
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3513
Country	:	US
Telephone Number	:	337-394-7774
Fax Number	:	337-394-8015

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

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	09/10/2016

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