Individual
CHAD JEREMY DOMANGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
1125 MARGUERITE ST, MORGAN CITY, LA 70380-1855
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP06871
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2306774
—
LA
Enumeration date
07/12/2012
Last updated
01/04/2016
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