Healthcare Provider Details

I. General information

NPI: 1992085799
Provider Name (Legal Business Name): BLAIR O LOUSTEAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD SUITE 7000
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

9418 BROOKLINE AVE STE A
BATON ROUGE LA
70809-1428
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-8829
  • Fax: 225-765-8283
Mailing address:
  • Phone: 225-490-6309
  • Fax: 225-765-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 06566
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: