Provider Demographics
NPI:1124108501
Name:DONOHUE, REBECCA B
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:B
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 JULIETTE PLACE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-232-2520
Mailing Address - Fax:337-232-9759
Practice Address - Street 1:500 JULIETTE PLACE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-232-2520
Practice Address - Fax:337-232-9759
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN087175 AP03613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432687Medicaid
LA1432687Medicaid
P13504Medicare UPIN