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General NPI Number Information
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NPI Number | 1477900298
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Entity Type | Individual
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Provider Name | NATHAN QUEBEDEAUX M.S., ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | SLU 10309
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City | HAMMOND
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State | LA
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Zip | 70402-0001
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Country | US
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Telephone | 985-549-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 4 LAURA DR APT C
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City | HAMMOND
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State | LA
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Zip | 70401-1002
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Country | US
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Telephone | 985-549-5133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 300908
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License Number State | LA
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