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General NPI Number Information
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NPI Number | 1205333622
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Entity Type | Individual
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Provider Name | REBECCA BULLARD EZELL FNP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 1850 GAUSE BLVD E STE 101
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City | SLIDELL
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State | LA
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Zip | 70461-5454
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Country | US
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Telephone | 985-639-3777
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Fax | 985-661-3578
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Provider Business Mailing Address
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Address Line | 1850 GAUSE BLVD E STE 101
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City | SLIDELL
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State | LA
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Zip | 70461-5454
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP09916
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License Number State | LA
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