Provider Demographics
NPI:1376944009
Name:MARTIN-DUHE, MONTRELL LATRAE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MONTRELL
Middle Name:LATRAE
Last Name:MARTIN-DUHE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0002
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4463 HWY 1 S STE A
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-5990
Practice Address - Country:US
Practice Address - Phone:225-448-5307
Practice Address - Fax:225-448-5021
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2378686Medicaid
LA2378686Medicaid