1336444264 NPI number — MRS. DAWNA CHRISTINE DEBLIEUX ACNP

Table of content: MRS. DAWNA CHRISTINE DEBLIEUX ACNP (NPI 1336444264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336444264 NPI number — MRS. DAWNA CHRISTINE DEBLIEUX ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBLIEUX
Provider First Name:
DAWNA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAY
Provider Other First Name:
DAWNA
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336444264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 KEYSER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-6018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-214-4470
Provider Business Mailing Address Fax Number:
318-214-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 KEYSER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457-6018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-214-4470
Provider Business Practice Location Address Fax Number:
318-214-4462
Provider Enumeration Date:
01/25/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  RN089347-AP06314 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)