Provider Demographics
NPI:1881992568
Name:BURRALL, PAULINE E (NP)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:E
Last Name:BURRALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-5800
Mailing Address - Fax:985-230-5859
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 201
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1431
Practice Address - Country:US
Practice Address - Phone:985-230-7440
Practice Address - Fax:985-230-7441
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2143808Medicaid
LAPENDINGMedicaid