Healthcare Provider Details

I. General information

NPI: 1497473268
Provider Name (Legal Business Name): DEANNA IBRAHIM APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 PARK ROWE AVE STE 200
BATON ROUGE LA
70810-1685
US

IV. Provider business mailing address

10101 PARK ROWE AVE STE 200
BATON ROUGE LA
70810-1685
US

V. Phone/Fax

Practice location:
  • Phone: 225-768-2164
  • Fax: 833-756-2680
Mailing address:
  • Phone: 225-769-2200
  • Fax: 833-756-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number210673
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number210673
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: