MARY MANCUSO HEAROD (NPI# 1144760414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144760414 |
| Entity Type | Individual |
| Full Name | MARY MANCUSO HEAROD |
| Credential | N.P. |
| Practice Address |
2615 Enterprise Blvd Suite B Lake Charles LA 70601-7686 |
| Mailing Address |
Po Box 122623 Dept 2623 Dallas TX 75312-2623 |
| Practice Telephone | 3374944785 |
| Practice Fax Number | 3374944786 |
| Mailing Telephone | 3374943058 |
| Mailing Fax Number | 3374942928 |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP09122 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2615 ENTERPRISE BLVD SUITE B |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70601-7686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083831887 | Clark A Gunderson | Orthopaedic Surgery | 2615 Enterprise Blvd, Lake Charles, LA 70601 | 2007-04-20 |
| 1861766321 | Clark A Gunderson Md Amc | Clinic/Center | 2615 Enterprise Blvd, Lake Charles, LA 70601-7686 | 2012-03-01 |
| 1427224765 | Sarpreet Singh Basra | Internal Medicine | 2615 Enterprise Blvd, Ste B, Lake Charles, LA 70601-7686 | 2008-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833872 | Fresenius Medical Care Sulphur, LLC | Clinic/Center | 330 Chavanne Street, Lake Charles, LA 70601 | 2020-08-24 |
| 1174158844 | Andrea Cormier | Peer Specialist | 751 E Bayou Pines Drive, Suite C, Lake Charles, LA 70601 | 2020-03-03 |
| 1588297303 | Vivian Claire Miller Monceaux | Chiropractor | 780 Bayou Pines East Drive, Lake Charles, LA 70601 | 2020-02-20 |
| 1568001014 | Swla Center for Health Services | Clinic/Center | 3820 Senator J. Bennett Johnston Ave, Charleston Bldg 8, Lake Charles, LA 70601 | 2020-01-02 |
| 1417512070 | Ryan Nathaniel Vaisler | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd., Lake Charles, LA 70601 | 2019-05-08 |
| 1336600675 | Hoh Palliative Care, LLC | Family Medicine | 750 East Bayou Pines, Suite A, Lake Charles, LA 70601 | 2019-03-28 |
| 1073079026 | Alawrass LLC | Pharmacy | 803 E Prien Lake Rd, Lake Charles, LA 70601 | 2019-02-14 |
| 1861962722 | Ellaweena Woods | Counselor | 1409 Kirkman St., Lake Charles, LA 70601 | 2018-12-04 |
| 1770051963 | Hanna Marie Rodriguez | Counselor | 751 Bayou Pines Drive, Suite C, Lake Charles, LA 70601 | 2018-11-06 |
| 1023585213 | Shandora Druilhet | Case Manager/Care Coordinator | 751 E Bayou Pines, Lake Charles, LA 70601 | 2018-10-26 |
| Find all providers in zip 70601 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942819131 | Alisha Bernard | Nurse Practitioner | 2469 Topsy Rd, Lake Charles, LA 70611-5724 | 2020-07-24 |
| 1699396473 | Patricia Duhon | Nurse Practitioner | 814 W Mcneese St Ste 100, Lake Charles, LA 70605-5426 | 2020-05-03 |
| 1134750052 | Lauren Goodaker | Nurse Practitioner | 230 W Sale Rd, Lake Charles, LA 70605-2828 | 2020-01-29 |
| 1043867997 | Cynthia Trahan Cox | Nurse Practitioner | 730 Tallow Rd, Lake Charles, LA 70607-7038 | 2019-08-23 |
| 1770145526 | Lexie Miller | Nurse Practitioner | 1874 Poeyfarre Rd, Lake Charles, LA 70611-4698 | 2019-07-02 |
| 1477116036 | Sarah Ardoin Bardin | Nurse Practitioner | 401 Dr Michael Debakey Dr Ste 300, Lake Charles, LA 70601-5864 | 2019-04-19 |
| 1194288266 | Lauryn Caitlin Leslie | Nurse Practitioner | 333 Doctor Michael Debakey Dr Ste 140, Lake Charles, LA 70601-5889 | 2019-04-07 |
| 1649735234 | Kayleigh Paige Head | Nurse Practitioner | 1000 Walters St Rm 204, Lake Charles, LA 70607-4647 | 2019-02-07 |
| 1548734270 | Traci L. Johnson | Nurse Practitioner | 4150 Nelson Rd Ste 5, Lake Charles, LA 70605-4148 | 2019-01-16 |
| 1730662305 | Brandy Laurice Semien | Nurse Practitioner | 1727 Imperial Blvd Bldg 1b, Lake Charles, LA 70605-5392 | 2018-09-10 |
| Find all providers in LAKE CHARLES | ||||
| City | LAKE CHARLES |
| Zip Code | 70601 |
Please comment or provide details below to improve the information on MARY MANCUSO HEAROD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.