Most Relevant Information
Provider Data
| NPI Number: | 1003371840 |
| Provider Name: | BRANDI RENE BOUTTE FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 203614 |
Most Important Dates
| Enumeration Date: | 02/06/2019 |
| Last Updated: | 02/06/2019 |
Provider Practice Location
1101 KALISTE SALOOM RD STE 304
LAFAYETTE
LA
705085705
Practice Location Phone/Fax
| Phone: | 3379885646 |
| Fax: | 3377690031 |
Provider Mailing Location
1101 KALISTE SALOOM RD STE 304
LAFAYETTE
LA
705085705
Provider Mailing Phone/Fax
| Phone: | 3379885646 |
| Fax: | 3377960031 |