Provider Demographics
NPI:1649771783
Name:FONTENOT, ELIZABETH (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 ALBERT HART DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5807
Mailing Address - Country:US
Mailing Address - Phone:225-802-9650
Mailing Address - Fax:
Practice Address - Street 1:7941 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3536
Practice Address - Country:US
Practice Address - Phone:225-761-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09846367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife