Provider Demographics
NPI:1417932906
Name:FAUCHEAUX, NANCY T (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:T
Last Name:FAUCHEAUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:T
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8120 MAIN ST
Mailing Address - Street 2:STE 301
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3403
Mailing Address - Country:US
Mailing Address - Phone:985-873-2961
Mailing Address - Fax:985-873-9074
Practice Address - Street 1:8120 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3403
Practice Address - Country:US
Practice Address - Phone:985-850-6653
Practice Address - Fax:985-872-1420
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN078437363L00000X
LAAP03591363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1569534Medicaid
LA4B416Medicare ID - Type Unspecified
LA1569534Medicaid