Provider Demographics
NPI:1003869942
Name:DALFERES, PATRICIA GARNER (NP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:GARNER
Last Name:DALFERES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 SOUTH MAGNOLIA STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-247-4567
Mailing Address - Fax:985-269-7091
Practice Address - Street 1:1402S MAGNOLIA ST A
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5020
Practice Address - Country:US
Practice Address - Phone:985-247-4567
Practice Address - Fax:985-269-7091
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN083034-AP02346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141232Medicaid
LA4C473Medicare PIN
LAP72063Medicare UPIN