Individual
BLAKE LAROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
400 N ACADIA RD, THIBODAUX, LA 70301-4856
(985) 493-4004
Mailing address
118 RUE CELESTE, THIBODAUX, LA 70301-5007
(985) 803-0638
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201963
LA
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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