Provider Demographics
NPI:1285654731
Name:DOMINGUE, AVIS SCHOELEN (MA, RD,LDN,CDE)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:SCHOELEN
Last Name:DOMINGUE
Suffix:
Gender:F
Credentials:MA, RD,LDN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARTIN PREJEAN RD
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5219
Mailing Address - Country:US
Mailing Address - Phone:337-886-7486
Mailing Address - Fax:
Practice Address - Street 1:501 MARTIN PREJEAN RD
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5219
Practice Address - Country:US
Practice Address - Phone:337-886-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C131OtherMEDICAL NUTRITION THERAPY