MEDICARE: AUDUBON FAMILY MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1568060135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDUBON FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	11268 WAVERLY DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-3417
Country	:	US
Telephone Number	:	504-220-5733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 MOSS ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-2125
Country	:	US
Telephone Number	:	504-220-5733
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	BRANDI NUNEZ WASHINGTON
Credential	:	FNP
Telephone Number	:	504-220-5733

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/15/2020

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