Provider Demographics
NPI:1659526895
Name:FUSELIER, WENDY CHAMPAGNE (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:CHAMPAGNE
Last Name:FUSELIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CHAMPAGNE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3734
Mailing Address - Country:US
Mailing Address - Phone:337-332-3500
Mailing Address - Fax:337-332-3200
Practice Address - Street 1:1525 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3401
Practice Address - Country:US
Practice Address - Phone:337-442-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10410RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C542PA79OtherPA PTAN