Provider Demographics
NPI:1629004064
Name:BEEBE, LOTTIE
Entity Type:Individual
Prefix:
First Name:LOTTIE
Middle Name:
Last Name:BEEBE
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 1:525 CLAUSE DR
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4708
Mailing Address - Country:US
Mailing Address - Phone:337-332-4005
Mailing Address - Fax:337-332-6671
Practice Address - Street 1:525 CLAUSE DR
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4708
Practice Address - Country:US
Practice Address - Phone:337-332-4005
Practice Address - Fax:337-332-6671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1623679372600000X
LA14691813747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1623679Medicaid
LA1469181Medicaid