Healthcare Provider Details

I. General information

NPI: 1114609757
Provider Name (Legal Business Name): ERICA E DEROUEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 W JUDGE PEREZ DR
CHALMETTE LA
70043-1734
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 504-575-3712
  • Fax: 504-575-3691
Mailing address:
  • Phone: 504-575-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number231376
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: