Provider Demographics
NPI:1467697532
Name:YVETTE M CHAMPAGNE
Entity Type:Organization
Organization Name:YVETTE M CHAMPAGNE
Other - Org Name:INDULGENCE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-392-5678
Mailing Address - Street 1:3821 PROMENADE PKWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540
Mailing Address - Country:US
Mailing Address - Phone:228-392-5678
Mailing Address - Fax:
Practice Address - Street 1:3821 PROMENADE PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-5374
Practice Address - Country:US
Practice Address - Phone:228-392-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier