Provider Demographics
NPI:1124701735
Name:BONVILLAIN, SUZANNE C (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:BONVILLAIN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EMT
Mailing Address - Street 1:600 VALHI BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5976
Mailing Address - Country:US
Mailing Address - Phone:985-872-3677
Mailing Address - Fax:
Practice Address - Street 1:600 VALHI BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5976
Practice Address - Country:US
Practice Address - Phone:985-872-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA131229163W00000X
LAF07230255363LF0000X
LA231514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner