Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 024449 | LA |
NPI | 1033146352 |
---|---|
Provider Name | Dr. Jennifer Claire Waguespack-Labiche |
First Address | Broussard, LA 70518-5096 |
Second Address | Broussard, LA 70518-5096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 31/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H93388 | (02) |