Healthcare Provider Details

I. General information

NPI: 1285748509
Provider Name (Legal Business Name): DIANA COUSIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7968 ESSEN PARK
BATON ROUGE LA
70809-7439
US

IV. Provider business mailing address

12623 E GLENHAVEN DR
BATON ROUGE LA
70815-6602
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-6700
  • Fax: 225-761-6760
Mailing address:
  • Phone: 225-761-6700
  • Fax: 225-761-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: