1598109225 NPI number — DR. RACHEL SHIREY DAUTERIVE M.D.

Table of content: DR. RACHEL SHIREY DAUTERIVE M.D. (NPI 1598109225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598109225 NPI number — DR. RACHEL SHIREY DAUTERIVE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAUTERIVE
Provider First Name:
RACHEL
Provider Middle Name:
SHIREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIREY
Provider Other First Name:
RACHEL
Provider Other Middle Name:
REANEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598109225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 TULANE AVE
Provider Second Line Business Mailing Address:
#8033
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-988-4700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 TULANE AVE
Provider Second Line Business Practice Location Address:
#8033
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70112-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-988-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2013

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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