Healthcare Provider Details

I. General information

NPI: 1073664009
Provider Name (Legal Business Name): MARY MARGARET GAUTREAU CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22601 HIGHWAY 190 E
ROBERT LA
70455-1731
US

IV. Provider business mailing address

22601 HIGHWAY 190 E
ROBERT LA
70455-1731
US

V. Phone/Fax

Practice location:
  • Phone: 504-236-5311
  • Fax: 985-542-2755
Mailing address:
  • Phone: 504-236-5311
  • Fax: 985-542-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN086761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: