Healthcare Provider Details

I. General information

NPI: 1477384808
Provider Name (Legal Business Name): MAUREEN ROGERS BREAUX RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN E ROGERS

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W HIGHWAY 30
GONZALES LA
70737-5003
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 225-664-1205
  • Fax: 225-644-5367
Mailing address:
  • Phone: 225-767-0847
  • Fax: 225-767-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2752
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: