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General NPI Number Information
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NPI Number | 1982339958
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Entity Type | Individual
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Provider Name | MARIAH BENSON BUTCHER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 180 N 5TH ST
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City | PONCHATOULA
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State | LA
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Zip | 70454-2532
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Country | US
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Telephone | 985-370-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 CATO ST
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City | BATON ROUGE
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State | LA
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Zip | 70808-1418
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Country | US
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Telephone | 985-974-7099
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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 | 226612
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License Number State | LA
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