Provider Demographics
NPI:1386783280
Name:THEUNISSEN, LACI LAFLEUR (MD)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:LAFLEUR
Last Name:THEUNISSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1206
Mailing Address - Country:US
Mailing Address - Phone:225-214-3199
Mailing Address - Fax:225-214-8011
Practice Address - Street 1:7855 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1206
Practice Address - Country:US
Practice Address - Phone:225-214-3199
Practice Address - Fax:225-214-8011
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37739207N00000X
OK24471207N00000X
LAMD.204409207N00000X
NE24598207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731795Medicaid
NE1002571500Medicaid
NE47068731778Medicaid
NE47068731746Medicaid
NE10025486000Medicaid
IA1386783280Medicaid
NE47068731713Medicaid
LA1074161Medicaid
NE47068731785Medicaid
NE47068731799Medicaid
IA1386783280Medicaid