Provider Demographics
NPI:1316410715
Name:LAFLEUR, JUSTIN SCOTT (LPN, CIT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SCOTT
Last Name:LAFLEUR
Suffix:
Gender:M
Credentials:LPN, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 LESTER ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-2009
Mailing Address - Country:US
Mailing Address - Phone:337-550-4882
Mailing Address - Fax:
Practice Address - Street 1:2020 W PINHOOK RD STE 504
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3212
Practice Address - Country:US
Practice Address - Phone:337-550-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20170345164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty