Healthcare Provider Details

I. General information

NPI: 1063821619
Provider Name (Legal Business Name): JESSICA LOMINAC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5727
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 337-436-3813
  • Fax: 337-439-0214
Mailing address:
  • Phone: 337-312-8284
  • Fax: 337-312-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07952
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: