Healthcare Provider Details

I. General information

NPI: 1992700272
Provider Name (Legal Business Name): MAUREEN ADRIAN POE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 1ST AVE
SULPHUR LA
70663-3424
US

IV. Provider business mailing address

6464 CORBINA RD
LAKE CHARLES LA
70607-7674
US

V. Phone/Fax

Practice location:
  • Phone: 337-526-6774
  • Fax: 337-375-0021
Mailing address:
  • Phone: 337-526-6774
  • Fax: 337-375-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP01864
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAP01864
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberAP01864
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: