Healthcare Provider Details

I. General information

NPI: 1982607420
Provider Name (Legal Business Name): ELIDIA ANNE DEWITT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 09/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9118 BLUEBONNET CENTRE BLVD
BATON ROUGE LA
70809-2993
US

IV. Provider business mailing address

PO BOX 62600 DEPT 1744
NEW ORLEANS LA
70162-0001
US

V. Phone/Fax

Practice location:
  • Phone: 225-368-2300
  • Fax: 225-368-2280
Mailing address:
  • Phone: 225-368-2300
  • Fax: 225-368-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04211
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: