Provider Demographics
NPI:1750386140
Name:WALDMEIER, LANCE
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:WALDMEIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-3707
Mailing Address - Country:US
Mailing Address - Phone:337-589-5951
Mailing Address - Fax:337-589-4031
Practice Address - Street 1:1611 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-3707
Practice Address - Country:US
Practice Address - Phone:337-589-5951
Practice Address - Fax:337-589-4031
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1439681Medicaid
LAP26726Medicare UPIN
LA4B722Medicare ID - Type Unspecified