Provider Demographics
NPI:1104149731
Name:BURAS, ELIZABETH THIBODEAUX (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THIBODEAUX
Last Name:BURAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22070 HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3606
Mailing Address - Country:US
Mailing Address - Phone:985-875-2379
Mailing Address - Fax:
Practice Address - Street 1:22070 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3606
Practice Address - Country:US
Practice Address - Phone:985-875-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06098363LF0000X
LARN107286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2109219Medicaid
MS01776292Medicaid
LA3B742Medicare PIN
LA2109219Medicaid