Provider Demographics
NPI:1124760301
Name:DUGAS, SHANTELL NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:NICOLE
Last Name:DUGAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 E SIMCOE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6534
Mailing Address - Country:US
Mailing Address - Phone:337-255-3124
Mailing Address - Fax:
Practice Address - Street 1:3103 E SIMCOE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6534
Practice Address - Country:US
Practice Address - Phone:337-255-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily