Provider Demographics
NPI:1922386879
Name:LEBRUN, MELISSA PERERA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:PERERA
Last Name:LEBRUN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:PERERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:17052 HUNTERS TRCE E
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4839
Mailing Address - Country:US
Mailing Address - Phone:225-939-0050
Mailing Address - Fax:
Practice Address - Street 1:214 S BURNSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3463
Practice Address - Country:US
Practice Address - Phone:225-647-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily