Individual
MR. CARROLL MARC CHAMPAGNE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.N.
Contact information
Practice address
UNIT 6, MEADOW LANE, CENTRAL LOUISIANA STATE HOSPITAL, PINEVILLE, LA 71360
(318) 484-6400
Mailing address
2747 HIGHWAY 28 E, APT 306, PINEVILLE, LA 71360-5700
(318) 449-9615
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
850513
LA
Other
Enumeration date
10/31/2006
Last updated
07/08/2007
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