Provider Demographics
NPI:1174888978
Name:CEFALU, JEAN ERICKSON (APRN, A/GNP, CWOCN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ERICKSON
Last Name:CEFALU
Suffix:
Gender:F
Credentials:APRN, A/GNP, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-2701
Mailing Address - Country:US
Mailing Address - Phone:985-290-7104
Mailing Address - Fax:
Practice Address - Street 1:1070 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-2701
Practice Address - Country:US
Practice Address - Phone:985-290-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07095363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health