Provider Demographics
NPI:1659356301
Name:FUSELIER, VICTOR WAYNE (PA)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:WAYNE
Last Name:FUSELIER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9143
Mailing Address - Country:US
Mailing Address - Phone:225-769-0933
Mailing Address - Fax:225-769-5008
Practice Address - Street 1:5231 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9143
Practice Address - Country:US
Practice Address - Phone:225-769-0933
Practice Address - Fax:225-769-5008
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10230363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1624781Medicaid
LA1624781Medicaid
LA5CE22P867Medicare PIN