Provider Demographics
NPI:1366640500
Name:DUVAL, DANETTE MARIE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:MARIE
Last Name:DUVAL
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:MARIE
Other - Last Name:DUGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:103 DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6944
Mailing Address - Country:US
Mailing Address - Phone:337-303-7456
Mailing Address - Fax:
Practice Address - Street 1:2390 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4205
Practice Address - Country:US
Practice Address - Phone:337-261-6480
Practice Address - Fax:337-266-4806
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN105325 AP05190363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health