Healthcare Provider Details

I. General information

NPI: 1053480848
Provider Name (Legal Business Name): ELIZABETH BREAUX MCELVEEN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 SUMMA AVE
BATON ROUGE LA
70809
US

IV. Provider business mailing address

18850 LA HWY 16
PORT VINCENT LA
70726
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5479
  • Fax: 225-761-5702
Mailing address:
  • Phone: 225-698-9206
  • Fax: 225-761-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN083790
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: