Healthcare Provider Details

I. General information

NPI: 1649771783
Provider Name (Legal Business Name): ELIZABETH FONTENOT APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 PICARDY AVE
BATON ROUGE LA
70809-3536
US

IV. Provider business mailing address

841 ALBERT HART DR
BATON ROUGE LA
70808-5807
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-1200
  • Fax:
Mailing address:
  • Phone: 225-802-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP09846
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: