=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760420244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANDY ERWIN DNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35701 LA HIGHWAY 16
-----------------------------------------------------
City | DENHAM SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70706-0548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-791-2400
-----------------------------------------------------
Fax | 225-791-4400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35701 LA HIGHWAY 16
-----------------------------------------------------
City | DENHAM SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70706-0548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-791-2400
-----------------------------------------------------
Fax | 225-791-4400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP04790
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------