Provider Demographics
NPI:1730512096
Name:MOBLEY-DUNOMES, ROSALIND (APRN-FNP-C)
Entity type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:
Last Name:MOBLEY-DUNOMES
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1544
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-1544
Mailing Address - Country:US
Mailing Address - Phone:225-763-1193
Mailing Address - Fax:877-870-5503
Practice Address - Street 1:2240 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2828
Practice Address - Country:US
Practice Address - Phone:985-348-6139
Practice Address - Fax:877-870-5503
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07529363LF0000X
LATAP003194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2350790Medicaid
LA2350790Medicaid