Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP07376 | LA |
NPI | 1003249640 |
---|---|
Provider Name | Lezette G. Vienne |
First Address | Lafayette, LA 70506-4205 |
Second Address | Lafayette, LA 70506-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2013 |
Last Update Date | 23/10/2017 |