Healthcare Provider Details

I. General information

NPI: 1174403752
Provider Name (Legal Business Name): MARIE THERESE CREDEUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16777 MEDICAL CENTER DR
BATON ROUGE LA
70816-3254
US

IV. Provider business mailing address

16777 MEDICAL CENTER DR
BATON ROUGE LA
70816-3254
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number227415
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: