Healthcare Provider Details

I. General information

NPI: 1225361827
Provider Name (Legal Business Name): MRS. PAULETTE GUIDRY LANDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U L LAFAYETTE STUDENT HEALTH 120 BOUCHER DR.
LAFAYETTE LA
70504-0001
US

IV. Provider business mailing address

325 LIPPI BLVD
LAFAYETTE LA
70508-3709
US

V. Phone/Fax

Practice location:
  • Phone: 337-482-6826
  • Fax: 337-482-6428
Mailing address:
  • Phone: 337-234-6510
  • Fax: 337-482-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPO1138
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: