Individual
LARRY DEJEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 HEYMANN BLVD, LAFAYETTE, LA 70503-2322
(337) 504-4279
(337) 504-4692
Mailing address
106 HEYMANN BLVD, LAFAYETTE, LA 70503-2322
(337) 504-4279
(337) 504-4692
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
950970
LA
Other
Enumeration date
09/06/2016
Last updated
09/06/2016
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