Healthcare Provider Details

I. General information

NPI: 1033505912
Provider Name (Legal Business Name): ERIN GENA MONACHELLO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNGSVILLE HWY STE 100
LAFAYETTE LA
70508-5173
US

IV. Provider business mailing address

809 SUMMER BREEZE DR APT 1307
BATON ROUGE LA
70810-6381
US

V. Phone/Fax

Practice location:
  • Phone: 337-330-0031
  • Fax:
Mailing address:
  • Phone: 225-907-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP08231
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: