Provider Demographics
NPI:1720803612
Name:CHATONEY-GAUTHREAUX, MARIEL ALEXA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:ALEXA
Last Name:CHATONEY-GAUTHREAUX
Suffix:
Gender:F
Credentials:MSN, 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 1:1530 E MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4784
Mailing Address - Country:US
Mailing Address - Phone:337-564-5322
Mailing Address - Fax:
Practice Address - Street 1:1530 E MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4784
Practice Address - Country:US
Practice Address - Phone:337-564-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP208751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily