Healthcare Provider Details

I. General information

NPI: 1518943836
Provider Name (Legal Business Name): MARY JAZAYERI NP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 AMBASSADOR CAFFERY PKWY BLDG C
LAFAYETTE LA
70508-6926
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-5239
  • Fax: 225-765-9886
Mailing address:
  • Phone: 337-470-5239
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number223793
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2198
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP03263
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number223793
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: