Individual
MRS. ELIZABETH JANE RIVAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3235 E CAUSEWAY APPROACH, MANDEVILLE, LA 70448-3451
(985) 875-2828
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
333911
LA
363A00000X
Physician Assistant
Primary
333911
LA
Other
Enumeration date
11/03/2022
Last updated
01/03/2023
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