Healthcare Provider Details

I. General information

NPI: 1538873278
Provider Name (Legal Business Name): STEPHANIE D TEZENO-ROSSYION FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CHAMPAGNE BLVD
BREAUX BRIDGE LA
70517-3700
US

IV. Provider business mailing address

210 CHAMPAGNE BLVD
BREAUX BRIDGE LA
70517-3700
US

V. Phone/Fax

Practice location:
  • Phone: 337-909-6154
  • Fax:
Mailing address:
  • Phone: 337-909-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number229204
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number096732
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: