Basic Information
| Provider Information | |||||||||
| NPI: | 1730475344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RABALAIS | ||||||||
| FirstName: | MIA | ||||||||
| MiddleName: | HEBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 LA VILLA CIR | ||||||||
| Address2: | |||||||||
| City: | YOUNGSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705925548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372073756 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 HUGH WALLIS RD S | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705082511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372331307 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP06575 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.