Provider Demographics
NPI:1982607420
Name:DEWITT, ELIDIA ANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:ELIDIA
Middle Name:ANNE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 62600 DEPT 1744
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70162-0001
Mailing Address - Country:US
Mailing Address - Phone:225-368-2300
Mailing Address - Fax:225-368-2280
Practice Address - Street 1:9118 BLUEBONNET CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2993
Practice Address - Country:US
Practice Address - Phone:225-368-2300
Practice Address - Fax:225-368-2280
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2019-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP04211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158691Medicaid
LA1158691Medicaid
LA266025YH83Medicare PIN
LAQ15419Medicare UPIN