=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003057076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNE NICOLE GAUTREAUX M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2009
-----------------------------------------------------
Last Update Date | 01/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6550 MAIN ST SUITE 2000
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-235-9308
-----------------------------------------------------
Fax | 225-658-1304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3822 MONTE VISTA DR
-----------------------------------------------------
City | ADDIS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70710-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-235-9308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD.204395
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------