Healthcare Provider Details

I. General information

NPI: 1912114711
Provider Name (Legal Business Name): THADDEUS J. LAVIGNE N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28050 WALKER RD S STE L
WALKER LA
70785-6047
US

IV. Provider business mailing address

PO BOX 2668
HAMMOND LA
70404-2668
US

V. Phone/Fax

Practice location:
  • Phone: 225-664-2111
  • Fax: 225-664-2888
Mailing address:
  • Phone: 985-230-3653
  • Fax: 985-370-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05168
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: