Provider Demographics
NPI:1033146352
Name:WAGUESPACK-LABICHE, JENNIFER CLAIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:WAGUESPACK-LABICHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:803 ALBERTSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5096
Mailing Address - Country:US
Mailing Address - Phone:337-839-2773
Mailing Address - Fax:337-839-2776
Practice Address - Street 1:803 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5096
Practice Address - Country:US
Practice Address - Phone:337-839-2773
Practice Address - Fax:337-839-2776
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA024449207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00337872Medicare PIN
H93388Medicare UPIN
LA4F415CU51Medicare PIN