Healthcare Provider Details

I. General information

NPI: 1942223904
Provider Name (Legal Business Name): LIZABETH G HATTAWAY APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S 6TH ST
LEESVILLE LA
71446-4482
US

IV. Provider business mailing address

506 S 6TH ST
LEESVILLE LA
71446-4482
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2234
  • Fax: 337-392-9383
Mailing address:
  • Phone: 337-239-2234
  • Fax: 337-392-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN054182 AP04763
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: