Provider Demographics
NPI:1235676404
Name:SCUDERI, EMILY CALLENS (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CALLENS
Last Name:SCUDERI
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 1:1408 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6140
Mailing Address - Country:US
Mailing Address - Phone:337-540-3803
Mailing Address - Fax:
Practice Address - Street 1:921 1ST AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-3424
Practice Address - Country:US
Practice Address - Phone:337-527-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily