Provider Demographics
NPI:1760011811
Name:FREITAS, MAURI (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAURI
Middle Name:
Last Name:FREITAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MAURI
Other - Middle Name:
Other - Last Name:FREITAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:172 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3024
Mailing Address - Country:US
Mailing Address - Phone:985-778-8621
Mailing Address - Fax:
Practice Address - Street 1:56 STARBRUSH CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7208
Practice Address - Country:US
Practice Address - Phone:985-246-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily