Provider Demographics
NPI:1124664891
Name:TEZENO, BRIGNETTE LACHELLE
Entity type:Individual
Prefix:
First Name:BRIGNETTE
Middle Name:LACHELLE
Last Name:TEZENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 DULLES DR APT 3202
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3081
Mailing Address - Country:US
Mailing Address - Phone:337-852-4165
Mailing Address - Fax:337-456-5799
Practice Address - Street 1:311 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6212
Practice Address - Country:US
Practice Address - Phone:337-662-3737
Practice Address - Fax:337-662-3636
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator