Provider Demographics
NPI:1598130148
Name:SMALL-ROUGEAU, SHIRLEY (MHP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SMALL-ROUGEAU
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4844
Mailing Address - Country:US
Mailing Address - Phone:318-332-1860
Mailing Address - Fax:
Practice Address - Street 1:1449 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4844
Practice Address - Country:US
Practice Address - Phone:318-332-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker