Provider Demographics
NPI:1508913195
Name:MCDANIEL, CHRISTINE DESSAUER (PAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DESSAUER
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 HIGHWAY 308
Mailing Address - Street 2:
Mailing Address - City:LAROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70373-2056
Mailing Address - Country:US
Mailing Address - Phone:985-798-7000
Mailing Address - Fax:985-798-7021
Practice Address - Street 1:13030 HIGHWAY 308
Practice Address - Street 2:
Practice Address - City:LAROSE
Practice Address - State:LA
Practice Address - Zip Code:70373-2056
Practice Address - Country:US
Practice Address - Phone:985-798-7000
Practice Address - Fax:985-798-7021
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10626.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1625132Medicaid
LAQ24338Medicare UPIN
LA5CJ03P596Medicare ID - Type Unspecified