Healthcare Provider Details

I. General information

NPI: 1871726083
Provider Name (Legal Business Name): ELLEN RITA LANDRENEAU CNS, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

IV. Provider business mailing address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

V. Phone/Fax

Practice location:
  • Phone: 337-266-4826
  • Fax: 337-266-4819
Mailing address:
  • Phone: 337-266-4826
  • Fax: 337-266-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN32394 AP01351
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: