Provider Demographics
NPI:1053522920
Name:BROWN, PAULA (RD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:PAULA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:636 DALE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2024
Mailing Address - Country:US
Mailing Address - Phone:985-502-4004
Mailing Address - Fax:985-280-9256
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-280-1554
Practice Address - Fax:985-280-9256
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA518133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C092Medicare PIN
LA4C092Medicare ID - Type UnspecifiedREGISTERED DIETITIAN