Provider Demographics
NPI:1942223904
Name:HATTAWAY, LIZABETH G (APRN FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LIZABETH
Middle Name:G
Last Name:HATTAWAY
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4482
Mailing Address - Country:US
Mailing Address - Phone:337-239-2234
Mailing Address - Fax:337-392-9383
Practice Address - Street 1:506 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4482
Practice Address - Country:US
Practice Address - Phone:337-239-2234
Practice Address - Fax:337-392-9383
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN054182 AP04763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1333603Medicaid
Q51475Medicare UPIN
LA4H620Medicare ID - Type Unspecified
LAQ51475Medicare UPIN