Provider Demographics
NPI:1073664009
Name:GAUTREAU, MARY MARGARET (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:GAUTREAU
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22601 HIGHWAY 190 E
Mailing Address - Street 2:
Mailing Address - City:ROBERT
Mailing Address - State:LA
Mailing Address - Zip Code:70455-1731
Mailing Address - Country:US
Mailing Address - Phone:504-236-5311
Mailing Address - Fax:985-542-2755
Practice Address - Street 1:22601 HIGHWAY 190 E
Practice Address - Street 2:
Practice Address - City:ROBERT
Practice Address - State:LA
Practice Address - Zip Code:70455-1731
Practice Address - Country:US
Practice Address - Phone:504-236-5311
Practice Address - Fax:985-542-2755
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN086761367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1527386Medicaid