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Individual

MR. JACOB ANTHONY CHAMPAGNE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
FNP-C

Contact information

Practice address
4801 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70508-6917
(337) 470-2911
Mailing address
133 MADDOX JUDE DR, MAURICE, LA 70555-3355
(337) 230-0104

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
224252
LA

Other

Enumeration date
02/09/2022
Last updated
02/09/2022
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