Detraz, Deirdre Irene

Detraz, Deirdre Irene is an sole proprietor health care provider with primary practice located at 2801 Kaliste Saloom Rd Suite 200 B, Lafayette LA 70508-7181. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Detraz, Deirdre Irene can be contacted via phone (337) 739-7278.

Contact Information

Primary practice address
2801 Kaliste Saloom Rd Suite 200 B Lafayette LA 70508-7181
Phone: (337) 739-7278
Fax: (337) 989-7036
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X APO 4805 Louisiana

Profile Details

NPI number 1396761060
LBN Legal business name Detraz, Deirdre Irene
Credentials ANP-C
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 14th, 2006
Last updated Nov 6th, 2012 - about 12 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 1396761060 NPPES
Louisiana MEDICAID 1031224

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