Healthcare Provider Details

I. General information

NPI: 1003318007
Provider Name (Legal Business Name): LAURA JANETTE PICHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GAUSE BLVD
SLIDELL LA
70458-2939
US

IV. Provider business mailing address

PO BOX 708847
SANDY UT
84070-8847
US

V. Phone/Fax

Practice location:
  • Phone: 985-280-8743
  • Fax:
Mailing address:
  • Phone: 866-869-2395
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number00000
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: