MEDICARE: DENISE LASHAWN MARIE PREJEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1053243626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE LASHAWN MARIE PREJEAN

Provider Business Mailing Address
First Line	:	912 CENTER ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-3902
Country	:	US
Telephone Number	:	337-255-2570
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 CENTER ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-3902
Country	:	US
Telephone Number	:	337-255-2570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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