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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386925683 NPPES
Louisiana MEDICAID 2386158

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