Provider Demographics
NPI:1972333706
Name:GAUDET, MARK JUDE (NP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JUDE
Last Name:GAUDET
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:2223 QUAIL RUN STE A2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9063
Mailing Address - Country:US
Mailing Address - Phone:225-454-9566
Mailing Address - Fax:225-416-6059
Practice Address - Street 1:17000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3246
Practice Address - Country:US
Practice Address - Phone:225-755-4396
Practice Address - Fax:225-755-4998
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA237033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily