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General NPI Number Information
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NPI Number | 1316227820
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Entity Type | Individual
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Provider Name | MICHELE MARIE BOUTIN FNP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1408 TECHE
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City | NEW ORLEANS
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State | LA
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Zip | 70114-5843
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Country | US
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Telephone | 504-365-8800
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Fax | 504-368-9836
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Provider Business Mailing Address
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Address Line | 2105 CLEARY AVE
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City | METAIRIE
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State | LA
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Zip | 70001-1623
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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 | TAP002663
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP06642
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License Number State | LA
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