Provider Demographics
NPI:1821742537
Name:DEAN, SUSETTE (APRN)
Entity Type:Individual
Prefix:
First Name:SUSETTE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:985-730-6970
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1416 GOBBLER HEAD DR
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-6091
Practice Address - Country:US
Practice Address - Phone:985-730-6970
Practice Address - Fax:985-735-8883
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA224267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA224267OtherSTATE LICENSE