Provider Demographics
NPI:1992813612
Name:NOEL, STELLA BOUSTANY (MD)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:BOUSTANY
Last Name:NOEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1211 COOLIDGE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2638
Mailing Address - Country:US
Mailing Address - Phone:337-235-9779
Mailing Address - Fax:337-235-0654
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2638
Practice Address - Country:US
Practice Address - Phone:337-235-9779
Practice Address - Fax:337-235-0654
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA017731207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1377635Medicaid
LA1377635Medicaid
54692Medicare ID - Type Unspecified