Individual
MS. SUSAN E MIEDECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5935 CAMERON ST, SCOTT, LA 70583-5182
(337) 264-0326
(337) 264-0328
Mailing address
PO BOX 52900, LAFAYETTE, LA 70505-2900
(337) 264-0326
(337) 264-0328
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
03861
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1102652
—
LA
Enumeration date
08/20/2006
Last updated
06/11/2008
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