Provider Demographics
NPI:1720211477
Name:MINET, ROXANE W (NP)
Entity Type:Individual
Prefix:
First Name:ROXANE
Middle Name:W
Last Name:MINET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BARATARIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3702
Mailing Address - Country:US
Mailing Address - Phone:504-340-6711
Mailing Address - Fax:
Practice Address - Street 1:1220 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3702
Practice Address - Country:US
Practice Address - Phone:504-340-6711
Practice Address - Fax:504-348-3935
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN103726363L00000X
LAAP05861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08485731Medicaid
LA1889857Medicaid
LA3B2607061Medicare PIN
LA1889857Medicaid