Provider Demographics
NPI:1720123078
Name:DUFRECHOU, NICOLE JULIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JULIE
Last Name:DUFRECHOU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0006
Mailing Address - Fax:225-765-9291
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-526-0006
Practice Address - Fax:225-765-9291
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200081.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355909Medicaid