Healthcare Provider Details

I. General information

NPI: 1184183089
Provider Name (Legal Business Name): LAUREN HEINEN THERIOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 2003B
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

5246 BRITTANY DR
BATON ROUGE LA
70808-9136
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0952
  • Fax:
Mailing address:
  • Phone: 225-757-4142
  • Fax: 225-757-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number327753
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: