Provider Demographics
NPI:1295280212
Name:MAYEUR, MICHELLE PRENTICE (NP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PRENTICE
Last Name:MAYEUR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MAUREEN
Other - Last Name:PRENTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 W HENFER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2470
Mailing Address - Country:US
Mailing Address - Phone:504-400-9164
Mailing Address - Fax:
Practice Address - Street 1:147 W HENFER AVE
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-2470
Practice Address - Country:US
Practice Address - Phone:504-400-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily