Provider Demographics
NPI:1144223207
Name:FREDERICK, LOUISE D (APRN, CNS)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:D
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2611
Mailing Address - Country:US
Mailing Address - Phone:337-289-8429
Mailing Address - Fax:337-289-8431
Practice Address - Street 1:441 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2611
Practice Address - Country:US
Practice Address - Phone:337-289-8429
Practice Address - Fax:337-289-8431
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01098364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C111DB73Medicare PIN
LA4C111CA94Medicare PIN
4C111Medicare ID - Type Unspecified
P49919Medicare UPIN