MEDICARE: ERICA RACHEL MARCOTTE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	280614	LA

General Provider Information

NPI Number	:	1043549082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA RACHEL MARCOTTE LPN

Provider Business Mailing Address
First Line	:	PO BOX 295
Second Line	:
City	:	CHARENTON
State	:	LA
Zip	:	70523-0295
Country	:	US
Telephone Number	:	337-578-0691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 CHINABERRY ST
Second Line	:
City	:	FRANKLIN
State	:	LA
Zip	:	70538-5236
Country	:	US
Telephone Number	:	337-828-1918
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	12/22/2009

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