Healthcare Provider Details

I. General information

NPI: 1568413227
Provider Name (Legal Business Name): MARY ELMA DUHON RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 AUDUBON BLVD SUITE 102
LAFAYETTE LA
70503-2676
US

IV. Provider business mailing address

629 MAIN ST
CANKTON LA
70584-5924
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-7801
  • Fax: 337-235-1865
Mailing address:
  • Phone: 337-668-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN031328
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO3101
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: