Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP03364 | LA |
NPI | 1043324684 |
---|---|
Provider Name | Dwayne Andras |
First Address | Thibodaux, LA 70302-5478 |
Second Address | Thibodaux, LA 70301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1569364 | (05) | LA |
573849 | (02) | LA |