Provider Demographics
NPI:1235977042
Name:CRAVEN, CHARLOTTE MARET LEBLANC
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARET LEBLANC
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2611
Mailing Address - Country:US
Mailing Address - Phone:337-289-8429
Mailing Address - Fax:337-289-8431
Practice Address - Street 1:441 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2611
Practice Address - Country:US
Practice Address - Phone:337-298-8429
Practice Address - Fax:337-298-8431
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily