Healthcare Provider Details

I. General information

NPI: 1427299411
Provider Name (Legal Business Name): ADRIENNE MUSUMECHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 CHEMIN METAIRIE RD SUITE B
YOUNGSVILLE LA
70592-5382
US

IV. Provider business mailing address

4809 AMBASSADOR CAFFERY PKWY SUITE 200
LAFAYETTE LA
70508-6917
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-8820
  • Fax: 337-988-8821
Mailing address:
  • Phone: 337-988-8803
  • Fax: 337-988-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number204617
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: