Healthcare Provider Details

I. General information

NPI: 1104202258
Provider Name (Legal Business Name): JESSICA G ZAUNBRECHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4345 NELSON RD STE 201
LAKE CHARLES LA
70605-4183
US

IV. Provider business mailing address

PO BOX 122205 DEPT 2205
DALLAS TX
75312-2205
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-6800
  • Fax: 337-494-6811
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08322
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: