Healthcare Provider Details

I. General information

NPI: 1124701735
Provider Name (Legal Business Name): SUZANNE C BONVILLAIN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE M MORGAN EMT

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VALHI BLVD
HOUMA LA
70360-5976
US

IV. Provider business mailing address

600 VALHI BLVD
HOUMA LA
70360-5976
US

V. Phone/Fax

Practice location:
  • Phone: 985-872-3677
  • Fax:
Mailing address:
  • Phone: 985-872-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number231514
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07230255
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number131229
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: