Healthcare Provider Details

I. General information

NPI: 1861701161
Provider Name (Legal Business Name): NOELLE R LEGER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 NELSON RD STE C10
LAKE CHARLES LA
70605-4169
US

IV. Provider business mailing address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-419-1960
  • Fax: 337-419-1961
Mailing address:
  • Phone: 337-312-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.200371
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: