Provider Demographics
NPI:1376169979
Name:ARIWODO, NANCY (NP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:ARIWODO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 BLUEBONNET DR UNIT 270
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3910
Mailing Address - Country:US
Mailing Address - Phone:337-307-5661
Mailing Address - Fax:
Practice Address - Street 1:225 RUE LA FRANCE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-1565
Practice Address - Country:US
Practice Address - Phone:337-565-0843
Practice Address - Fax:337-205-4150
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP146151363LP0808X
LA214368363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health