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3845 Elm St Ste 3 Choudrant LA 71227-3017 | |
(318) 695-9200 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 3845 Elm St Ste 3, Choudrant, Louisiana |
Authorized Official Name and Position | Jennifer S. Juneau (OWNER) |
Authorized Official Contact | 3186959200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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216 Loblolly Ln Choudrant LA 71227-4804 Ph: () - | 3845 Elm St Ste 3 Choudrant LA 71227-3017 Ph: (318) 695-9200 |
NPI Number | 1962267922 |
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Provider Enumeration Date | 02/19/2024 |
Last Update Date | 09/20/2024 |
Medicare PECOS PAC ID | 1052757416 |
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Medicare Enrollment ID | O20240308000368 |
Identifier | Type | State | Issuer |
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1962267922 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Provider Name | Jennifer S Juneau |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285981068 PECOS PAC ID: 3072737345 Enrollment ID: I20140609000277 |