Provider Demographics
NPI:1104541325
Name:MIRE, DEBORAH LEBEOUF (APRN-FNP-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEBEOUF
Last Name:MIRE
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23629 W LONNIE RD
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-6398
Mailing Address - Country:US
Mailing Address - Phone:337-849-3742
Mailing Address - Fax:
Practice Address - Street 1:211 N ADAMS AVE
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-5919
Practice Address - Country:US
Practice Address - Phone:337-306-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF09220919363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily