Healthcare Provider Details

I. General information

NPI: 1962406884
Provider Name (Legal Business Name): CLARA BASCO COUTEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 HIGHWAY 1
MARKSVILLE LA
71351-2650
US

IV. Provider business mailing address

5541 HIGHWAY 1
MARKSVILLE LA
71351-2650
US

V. Phone/Fax

Practice location:
  • Phone: 318-240-7240
  • Fax: 318-240-7780
Mailing address:
  • Phone: 318-240-7240
  • Fax: 318-240-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN038164
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: