Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 00000 | LA |
NPI | 1003318007 |
---|---|
Provider Name | Laura Janette Pichon |
First Address | Sandy, UT 84070-8847 |
Second Address | Slidell, LA 70458-2939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2018 |
Last Update Date | 06/03/2018 |