Provider Demographics
NPI:1730475344
Name:RABALAIS, MIA HEBERT
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:HEBERT
Last Name:RABALAIS
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 1:112 LA VILLA CIR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5548
Mailing Address - Country:US
Mailing Address - Phone:337-207-3756
Mailing Address - Fax:
Practice Address - Street 1:901 HUGH WALLIS RD S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2511
Practice Address - Country:US
Practice Address - Phone:337-233-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily