Provider Demographics
NPI:1033412275
Name:GODARE STEIN, REBECCA ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELLEN
Last Name:GODARE STEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8258
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:600 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5727
Practice Address - Country:US
Practice Address - Phone:337-436-3813
Practice Address - Fax:337-439-0214
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN059031 AP06292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2141422Medicaid
LA2141422Medicaid
LA3C1817460Medicare PIN