Healthcare Provider Details

I. General information

NPI: 1699473793
Provider Name (Legal Business Name): RENEE LAGRANGE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RUE LOUIS XIV BLDG 2
LAFAYETTE LA
70508-5739
US

IV. Provider business mailing address

1025 MIMS LN
BREAUX BRIDGE LA
70517-7205
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-6665
  • Fax: 337-534-0179
Mailing address:
  • Phone: 337-962-6231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229489
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: