Provider Demographics
NPI:1841026440
Name:MIMI LACOUTURE PLLC
Entity type:Organization
Organization Name:MIMI LACOUTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACOUTURE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:563-340-8470
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52767-0401
Mailing Address - Country:US
Mailing Address - Phone:563-340-8470
Mailing Address - Fax:563-202-7303
Practice Address - Street 1:1225 E RIVER DR STE 205
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5752
Practice Address - Country:US
Practice Address - Phone:563-340-8470
Practice Address - Fax:563-202-7303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIMI LACOUTURE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty