Provider Demographics
NPI:1245391960
Name:SEVIN, LENA OPITZ (PA-C)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:OPITZ
Last Name:SEVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PATRIOT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6831
Mailing Address - Country:US
Mailing Address - Phone:337-981-2125
Mailing Address - Fax:337-981-2174
Practice Address - Street 1:105 PATRIOT ST
Practice Address - Street 2:STE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6831
Practice Address - Country:US
Practice Address - Phone:337-981-2125
Practice Address - Fax:337-981-2174
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200041363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1598739Medicaid
LA1598739Medicaid
LA5CA91P700Medicare ID - Type Unspecified