Basic Information
| Provider Information | |||||||||
| NPI: | 1619556198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUCOTE | ||||||||
| FirstName: | MASON | ||||||||
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| Credential: | RN/APRN STUDENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 GRINAGE ST | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70360 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 HENRY CLAY AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS 70118 | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048999511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2021 | ||||||||
| LastUpdateDate: | 04/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0002X | 201953 | LA | Y | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care |
No ID Information.