=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992048425
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINE MARIE TEMPLET R.N., B.S.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2013
-----------------------------------------------------
Last Update Date | 04/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 N BURNSIDE AVE SUITE C, PMB #6
-----------------------------------------------------
City | GONZALES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70737-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-565-0663
-----------------------------------------------------
Fax | 188-877-4835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 N BURNSIDE AVENUE SUITE C PMB #6
-----------------------------------------------------
City | GONZALES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-565-0663
-----------------------------------------------------
Fax | 188-877-4835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | RN042697
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------