Healthcare Provider Details

I. General information

NPI: 1164417234
Provider Name (Legal Business Name): ELVINA ANN LORRAINE CHERAMIE APRNC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W 112TH ST
CUT OFF LA
70345-3629
US

IV. Provider business mailing address

114 W 63RD ST
CUT OFF LA
70345-3319
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-5567
  • Fax: 985-632-5573
Mailing address:
  • Phone: 985-632-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN047874 AP01206
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: