Provider Demographics
NPI:1669726287
Name:OUBRE, MIA PORTIER (FNP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:PORTIER
Last Name:OUBRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8490 PICARDY AVE
Mailing Address - Street 2:BLDG 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3731
Mailing Address - Country:US
Mailing Address - Phone:225-237-1754
Mailing Address - Fax:225-237-1722
Practice Address - Street 1:6615 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4261
Practice Address - Country:US
Practice Address - Phone:225-819-1190
Practice Address - Fax:225-819-1199
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2016-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP06968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2364766Medicaid
MS00531845Medicaid
MS00531845Medicaid