Provider Demographics
NPI:1861701161
Name:LEGER, NOELLE R (PAC)
Entity type:Individual
Prefix:MISS
First Name:NOELLE
Middle Name:R
Last Name:LEGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8284
Mailing Address - Fax:
Practice Address - Street 1:4150 NELSON RD STE C10
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4169
Practice Address - Country:US
Practice Address - Phone:337-419-1960
Practice Address - Fax:337-419-1961
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200371363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2148613Medicaid
LA379045YH5NMedicare PIN
LA2148613Medicaid
LAP01605557Medicare PIN
LA379045YXUAMedicare PIN