MEDICARE: MS. GWENDOLYN JANIS LEMAIRE NP

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	363LF0000X	Family Nurse Practitioner	RN081642 AP01729	LA

General Provider Information

NPI Number	:	1821087545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWENDOLYN JANIS LEMAIRE NP

Provider Business Mailing Address
First Line	:	PO BOX 3111
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-0111
Country	:	US
Telephone Number	:	337-531-3609
Fax Number	:	337-531-3551

Provider Business Practice Location Address
First Line	:	1585 3RD ST
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5102
Country	:	US
Telephone Number	:	337-531-3609
Fax Number	:	337-531-3551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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