Provider Demographics
NPI:1861058752
Name:DAIGLE, CHRISTINA (MPAS, MLA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:MPAS, MLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 CEDARLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5413
Mailing Address - Country:US
Mailing Address - Phone:504-920-0708
Mailing Address - Fax:
Practice Address - Street 1:1057 PAUL MAILLARD RD STE 2210
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4349
Practice Address - Country:US
Practice Address - Phone:504-722-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical