Healthcare Provider Details

I. General information

NPI: 1508913195
Provider Name (Legal Business Name): CHRISTINE DESSAUER MCDANIEL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 HIGHWAY 308
LAROSE LA
70373-2056
US

IV. Provider business mailing address

13030 HIGHWAY 308
LAROSE LA
70373-2056
US

V. Phone/Fax

Practice location:
  • Phone: 985-798-7000
  • Fax: 985-798-7021
Mailing address:
  • Phone: 985-798-7000
  • Fax: 985-798-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.A10626.RX
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: