Provider Demographics
NPI:1285671610
Name:DEBLANC, DONALYN M (FNP)
Entity Type:Individual
Prefix:
First Name:DONALYN
Middle Name:M
Last Name:DEBLANC
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 1:441 WALL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7723
Mailing Address - Country:US
Mailing Address - Phone:504-371-6550
Mailing Address - Fax:504-371-6555
Practice Address - Street 1:441 WALL BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7723
Practice Address - Country:US
Practice Address - Phone:504-371-6550
Practice Address - Fax:504-371-6555
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2014-10-23
Deactivation Date:2013-10-17
Deactivation Code:
Reactivation Date:2013-11-01
Provider Licenses
StateLicense IDTaxonomies
LAAP2903363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01903009Medicaid
LA1532304Medicaid
MS01903009Medicaid
LA5X439Medicare ID - Type Unspecified
LA339287YH3UMedicare PIN