Provider Demographics
NPI:1568101095
Name:BEAUCHAMP, MAISHA LASHAWN
Entity Type:Individual
Prefix:
First Name:MAISHA
Middle Name:LASHAWN
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-2838
Mailing Address - Country:US
Mailing Address - Phone:225-522-0502
Mailing Address - Fax:
Practice Address - Street 1:1434 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-2838
Practice Address - Country:US
Practice Address - Phone:225-522-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010781841343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA842737387Medicaid