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General NPI Number Information
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NPI Number | 1336475813
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Entity Type | Individual
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Provider Name | MONIQUE BIANCA DECLOUET-DIXON FNP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2001 MOSS ST STE 1200
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City | LAFAYETTE
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State | LA
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Zip | 70501
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Country | US
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Telephone | 337-761-0211
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Fax | 337-227-6272
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Provider Business Mailing Address
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Address Line | PO BOX 740012
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City | ATLANTA
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State | GA
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Zip | 30374-0012
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Country | US
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Telephone | 312-733-9730
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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 | AP059059
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License Number State | LA
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