Doctor Name: | CHARLES LEBRIJA |
NPI Number: | 1811232002 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | AP07097 |
Business Practice Address: | 326 N Hood St Lake Providence, LA - 712542140 |
Business Phone Number: | 3185594900 |
Business Fax Number: | 3185591772 |
Mailing Address: | 505 Lake St, LAKE PROVIDENCE |
State: | LA |
Postal Code: | 712542545 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/29/2012 |
NPI Last Update Date: | 11/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP07097 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |