1306507447 NPI number — MS. GABRIELLE LATARI NEWTON NP

Table of content: MS. GABRIELLE LATARI NEWTON NP (NPI 1306507447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306507447 NPI number — MS. GABRIELLE LATARI NEWTON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWTON
Provider First Name:
GABRIELLE
Provider Middle Name:
LATARI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1306507447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 724
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEITHVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71047-0724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-674-0801
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE PEDIATRIC CENTER
Provider Second Line Business Practice Location Address:
315 S HIGHLAND DRIVE SUITE A
Provider Business Practice Location Address City Name:
MANY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-431-5100
Provider Business Practice Location Address Fax Number:
318-808-7007
Provider Enumeration Date:
12/30/2021

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: 363LP0808X , with the licence number:  222243 , 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)





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