Individual
CHAMP PHUPHANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
305 E 1ST ST, THIBODAUX, LA 70301-3341
(985) 228-6028
Mailing address
305 E 1ST ST, THIBODAUX, LA 70301-3341
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
224407
LA
Other
Enumeration date
03/04/2022
Last updated
04/16/2024
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