Healthcare Provider Details

I. General information

NPI: 1750989190
Provider Name (Legal Business Name): BRIDGETTE LYNETTE AZOANEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 LAKE SHERWOOD AVE E
BATON ROUGE LA
70816-7322
US

IV. Provider business mailing address

4119 LAKE SHERWOOD AVE E
BATON ROUGE LA
70816-7322
US

V. Phone/Fax

Practice location:
  • Phone: 225-485-6439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11002
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: