=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265517965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE JANE QUATMAN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 827 BAYOU GARDENS BLVD
-----------------------------------------------------
City | HOUMA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70364-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-853-2343
-----------------------------------------------------
Fax | 985-853-0589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 827 BAYOU GARDENS BLVD
-----------------------------------------------------
City | HOUMA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70364-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-853-2343
-----------------------------------------------------
Fax | 985-853-0589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP04796
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------