Healthcare Provider Details

I. General information

NPI: 1336194828
Provider Name (Legal Business Name): GWEN MARIE COUSINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GALLERIA BLVD STE 900
METAIRIE LA
70001-7528
US

IV. Provider business mailing address

1 GALLERIA BLVD STE 900
METAIRIE LA
70001-7528
US

V. Phone/Fax

Practice location:
  • Phone: 504-895-3961
  • Fax: 504-888-6045
Mailing address:
  • Phone: 504-456-9061
  • Fax: 504-888-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number024983
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number024983
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: