Provider Demographics
NPI:1972173649
Name:SOILEAU, SHAWN MICHAEL (FNP-C)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:SOILEAU
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39156 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4856
Mailing Address - Country:US
Mailing Address - Phone:225-892-7641
Mailing Address - Fax:
Practice Address - Street 1:5207 ESSEN LN STE 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3565
Practice Address - Country:US
Practice Address - Phone:225-930-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218920261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care