Provider Demographics
NPI:1225185564
Name:FONTENETTE, GILBERT LASHAWN (NP)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:LASHAWN
Last Name:FONTENETTE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 AMBASSADOR CAFFERY PKWY STE 401A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7265
Mailing Address - Country:US
Mailing Address - Phone:337-470-3040
Mailing Address - Fax:337-470-3052
Practice Address - Street 1:4811 AMBASSADOR CAFFERY PKWY STE 401A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7265
Practice Address - Country:US
Practice Address - Phone:337-470-3040
Practice Address - Fax:337-470-3052
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner