1497802946 NPI number — MS. EURICA GASTON APRN-CNP

Table of content: MS. EURICA GASTON APRN-CNP (NPI 1497802946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497802946 NPI number — MS. EURICA GASTON APRN-CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASTON
Provider First Name:
EURICA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497802946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70879-8108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-421-1686
Provider Business Mailing Address Fax Number:
225-349-7392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12097 OLD HAMMOND HWY STE G1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-8679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-421-1686
Provider Business Practice Location Address Fax Number:
225-349-7392
Provider Enumeration Date:
01/05/2007

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: 363LF0000X , with the licence number:  AP03545 RN079325 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN03545 , 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)

  • Identifier: 1568082 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".