Provider Demographics
NPI:1184704397
Name:PASQUA, CLAIRE (APRN BC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:PASQUA
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769
Mailing Address - Country:US
Mailing Address - Phone:225-744-1111
Mailing Address - Fax:225-744-4919
Practice Address - Street 1:16260 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIESVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769
Practice Address - Country:US
Practice Address - Phone:225-744-1111
Practice Address - Fax:225-744-4919
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN041469 AP05048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584967Medicaid
3A024Medicare PIN
LA1584967Medicaid