Provider Demographics
NPI:1811189087
Name:CLAVILLE, JONI NICOLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:NICOLE
Last Name:CLAVILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JONI
Other - Middle Name:NICOLE
Other - Last Name:BRANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5825 AIRLINE HWY
Mailing Address - Street 2:EMERGENCY MEDICINE RESIDENCY PROGRAM
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-2408
Mailing Address - Country:US
Mailing Address - Phone:225-358-3940
Mailing Address - Fax:
Practice Address - Street 1:5825 AIRLINE HWY
Practice Address - Street 2:EMERGENCY MEDICINE RESIDENCY PROGRAM
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-2408
Practice Address - Country:US
Practice Address - Phone:225-358-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAS33513114404207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1005207Medicaid