Individual
MARY BETH GAUDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CANP
Contact information
Practice address
42388 PELICAN PROFESSIONAL PARK, HAMMOND, LA 70403
(985) 542-6251
Mailing address
167 SOUTH GATE, PONCHATOULA, LA 70454
(985) 542-6251
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP03655
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1495948
—
LA
01
—
30051
LA CONTROL #
LA
01
—
AP03655
STATE LICENSE #
LA
Enumeration date
06/30/2006
Last updated
03/07/2023
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