1154175701 NPI number — LAQUANTA DEONDRIGUE FONTENOT NP

Table of content: LAQUANTA DEONDRIGUE FONTENOT NP (NPI 1154175701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154175701 NPI number — LAQUANTA DEONDRIGUE FONTENOT NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTENOT
Provider First Name:
LAQUANTA
Provider Middle Name:
DEONDRIGUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FONTENOT
Provider Other First Name:
LAQUANTA
Provider Other Middle Name:
DEONDRIGUE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1154175701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 W OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMITE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70422-2754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-974-9476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 W OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMITE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70422-2754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-323-1504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  234551 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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