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General NPI Number Information
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NPI Number | 1912114711
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Entity Type | Individual
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Provider Name | THADDEUS J. LAVIGNE N.P.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 28050 WALKER RD S STE L
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City | WALKER
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State | LA
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Zip | 70785-6047
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Country | US
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Telephone | 225-664-2111
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Fax | 225-664-2888
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Provider Business Mailing Address
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Address Line | PO BOX 2668
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City | HAMMOND
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State | LA
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Zip | 70404-2668
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Country | US
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Telephone | 985-230-3653
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Fax | 985-370-7409
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP05168
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License Number State | LA
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