Provider Demographics
NPI:1194031237
Name:DINVAUT, GRACE EKANEM (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:EKANEM
Last Name:DINVAUT
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 1:806 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5727
Mailing Address - Country:US
Mailing Address - Phone:337-365-4945
Mailing Address - Fax:318-256-8136
Practice Address - Street 1:1050 N ROBINSON ST
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449
Practice Address - Country:US
Practice Address - Phone:318-256-8150
Practice Address - Fax:318-256-8136
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
58-2164455OtherTAX ID
LAPA021170CSOtherPRESCRIPTIVE AUTHORITY
LACDS.041111-APNOtherCDS
LA2129180Medicaid
LA2129180Medicaid