Individual
LAKSAMANA PERINTIS NUSANTARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
401 YOUNGSVILLE HWY STE 100, LAFAYETTE, LA 70508-5173
(337) 451-0663
(337) 205-8650
Mailing address
401 YOUNGSVILLE HWY STE 100, LAFAYETTE, LA 70508-5173
(337) 451-0663
(337) 205-8650
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
11027192
FL
363LP2300X
Primary Care Nurse Practitioner
Primary
234786
LA
Other
Enumeration date
08/24/2023
Last updated
10/23/2025
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