Declouet, Mark
Declouet, Mark is an sole proprietor health care provider with primary practice located at 315 Audubon Blvd , Lafayette LA 70503-2610. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Declouet, Mark can be contacted via phone (337) 522-7573.Contact Information
Primary practice address
315 Audubon Blvd
Lafayette LA 70503-2610
Phone: (337) 522-7573
Fax: (337) 210-3058
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | AP08202 | Louisiana |
Profile Details
| NPI number | 1386925683 |
|---|---|
| LBN Legal business name | Declouet, Mark |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 31st, 2011 |
| Last updated | Dec 29th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386925683 | NPPES |
| Louisiana | MEDICAID | 2386158 |
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