Provider Demographics
NPI:1962427609
Name:BURDEAUX, RHONDA P (APRN BC)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:P
Last Name:BURDEAUX
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 STANDARD REED RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1609
Mailing Address - Country:US
Mailing Address - Phone:318-396-6807
Mailing Address - Fax:318-396-6807
Practice Address - Street 1:1117 CHENIERE DREW RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8551
Practice Address - Country:US
Practice Address - Phone:318-329-4370
Practice Address - Fax:318-329-4356
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN059895363L00000X
LAAP04819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A293CY35Medicare PIN