Provider Demographics
NPI:1477384808
Name:BREAUX, MAUREEN ROGERS (RDN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ROGERS
Last Name:BREAUX
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:E
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5215 ESSEN LN STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3543
Mailing Address - Country:US
Mailing Address - Phone:225-767-0847
Mailing Address - Fax:225-767-1335
Practice Address - Street 1:1104 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5003
Practice Address - Country:US
Practice Address - Phone:225-664-1205
Practice Address - Fax:225-644-5367
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2752133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered