Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP09827 | LA |
NPI | 1003301532 |
---|---|
Provider Name | Michael Stephen Robichaux |
First Address | Lafayette, LA 70503-2632 |
Second Address | Lafayette, LA 70503-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 27/06/2018 |