Healthcare Provider Details

I. General information

NPI: 1942931076
Provider Name (Legal Business Name): JAMIE LANCON APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 S MORGAN AVE
BROUSSARD LA
70518-4921
US

IV. Provider business mailing address

117 THRUSH LOOP
LAFAYETTE LA
70508-6218
US

V. Phone/Fax

Practice location:
  • Phone: 337-453-4346
  • Fax:
Mailing address:
  • Phone: 337-258-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number219429
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: