Basic Information
| Provider Information | |||||||||
| NPI: | 1689030140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAUDEAN | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 RIDGEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703012725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854479045 | ||||||||
| FaxNumber: | 9854473349 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 RIDGEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703012725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854479045 | ||||||||
| FaxNumber: | 9854473349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP08591 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.