Healthcare Provider Details

I. General information

NPI: 1376384461
Provider Name (Legal Business Name): ELAINE ROLEN STANDLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 BROADMOOR BLVD
MONROE LA
71201-2987
US

IV. Provider business mailing address

2503 BROADMOOR BLVD
MONROE LA
71201-2987
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-6050
  • Fax: 318-388-2024
Mailing address:
  • Phone: 318-388-6050
  • Fax: 318-388-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number237079
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN085307
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: