Provider Demographics
NPI:1841857778
Name:ARDOIN, CHARLOTTE RENEE' (FNP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:RENEE'
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:LACASSINE
Mailing Address - State:LA
Mailing Address - Zip Code:70650-0134
Mailing Address - Country:US
Mailing Address - Phone:337-794-2238
Mailing Address - Fax:
Practice Address - Street 1:1106 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5252
Practice Address - Country:US
Practice Address - Phone:337-497-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP202271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily