Provider Demographics
NPI:1013189125
Name:DAKIN, JEANNE BIENVENU (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:BIENVENU
Last Name:DAKIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:BIENVENU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1027 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-2325
Mailing Address - Country:US
Mailing Address - Phone:985-649-0513
Mailing Address - Fax:985-646-5488
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5520
Practice Address - Country:US
Practice Address - Phone:985-646-5488
Practice Address - Fax:985-646-5720
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03986363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1142620Medicaid