Provider Demographics
NPI:1124367289
Name:GUILBEAUX, LESLIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GUILBEAUX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 FOREMAN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6211
Mailing Address - Country:US
Mailing Address - Phone:337-298-7316
Mailing Address - Fax:
Practice Address - Street 1:200 BEAULLIEU DR
Practice Address - Street 2:BUILDING 9A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-456-3323
Practice Address - Fax:337-456-4638
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily