Provider Demographics
NPI:1255471678
Name:DUFRENE, HOLLY L (MNT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:DUFRENE
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2865
Mailing Address - Country:US
Mailing Address - Phone:985-872-6666
Mailing Address - Fax:985-872-3263
Practice Address - Street 1:4722 HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2865
Practice Address - Country:US
Practice Address - Phone:985-872-6666
Practice Address - Fax:985-872-3263
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C773Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LA4C7739651Medicare PIN