Individual
WANDA LYNN PEZANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3501 HIGHWAY 10, JACKSON, LA 70748-6238
(225) 683-5292
(225) 683-3411
Mailing address
PO BOX 395, CLINTON, LA 70722-0395
(225) 683-5292
(225) 683-3411
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0812093
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2318543
—
LA
Enumeration date
09/05/2012
Last updated
02/27/2014
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