Provider Demographics
NPI:1730434432
Name:CUTTING, EVA JUNE MATILDA (PA-C)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:JUNE MATILDA
Last Name:CUTTING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HANSON DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8012
Mailing Address - Country:US
Mailing Address - Phone:318-773-4684
Mailing Address - Fax:
Practice Address - Street 1:204 HANSON DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-8012
Practice Address - Country:US
Practice Address - Phone:318-773-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1625183Medicaid
LA248838YH4EMedicare PIN