Provider Demographics
NPI:1114609757
Name:DEROUEN, ERICA E (FNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:E
Last Name:DEROUEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4605
Mailing Address - Country:US
Mailing Address - Phone:504-575-3712
Mailing Address - Fax:
Practice Address - Street 1:8050 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1734
Practice Address - Country:US
Practice Address - Phone:504-575-3712
Practice Address - Fax:504-575-3691
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily