Healthcare Provider Details

I. General information

NPI: 1205768231
Provider Name (Legal Business Name): SHAN-COA BURKE DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 HOLMES BLVD # 207
GRETNA LA
70056-2800
US

IV. Provider business mailing address

559 HOLMES BLVD
GRETNA LA
70056-2800
US

V. Phone/Fax

Practice location:
  • Phone: 504-909-0926
  • Fax:
Mailing address:
  • Phone: 504-909-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBD471433
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: