Provider Demographics
NPI:1568724490
Name:MCCUTCHEON, MARY JANE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:MCCUTCHEON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12080 MARSTON ST
Mailing Address - Street 2:POB 227
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-3217
Mailing Address - Country:US
Mailing Address - Phone:225-683-8551
Mailing Address - Fax:225-683-3788
Practice Address - Street 1:12080 MARSTON ST
Practice Address - Street 2:POB 227
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-3217
Practice Address - Country:US
Practice Address - Phone:225-683-8551
Practice Address - Fax:225-683-3788
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55665163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health