1669474797 NPI number — MRS. CAROLYN SUE LEMOINE CPNP

Table of content: MRS. CAROLYN SUE LEMOINE CPNP (NPI 1669474797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669474797 NPI number — MRS. CAROLYN SUE LEMOINE CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMOINE
Provider First Name:
CAROLYN
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
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:
1669474797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 FOXFIRE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-445-3924
Provider Business Mailing Address Fax Number:
318-964-2494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. FRANCES CABRINI HOSPITAL SCHOOL BASED CENTERS
Provider Second Line Business Practice Location Address:
3330 MASONIC DR.
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-964-2492
Provider Business Practice Location Address Fax Number:
318-964-2494
Provider Enumeration Date:
06/01/2005

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: 363LP0200X , with the licence number:  RN035465 AP03357 , 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: 1571644 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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