Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
LAKSAMANA PERINTIS NUSANTARA, NP
DeactivatedLAKSAMANA PERINTIS NUSANTARA, NP is a Primary Care Nurse Practitioner healthcare provider located in LAFAYETTE, Louisiana. NPI 1205610607 is deactivated in the NPPES registry. Verify at CMS.
Primary Care Nurse Practitioner · LAFAYETTE, LA
This NPI has been deactivated.
The record was deactivated on April 18, 2024.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1205610607
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 24, 2023 (0.65027322404372 yrs)
- Last Updated
- Oct 23, 2025
- Deactivated
- Apr 18, 2024
- Licenses
-
11027192 (FL)234786 (LA)
Practice Information
- Address
-
401 YOUNGSVILLE HWY STE 100LAFAYETTE, LA, 705085173Browse LA providers · Browse ZIP 70508
- Phone
- 3374510663
- Fax
- 3372058650
- Primary Specialty
-
Primary Care Nurse Practitioner
363LP2300X
- Additional Specialty
- Primary Care Nurse Practitioner
Other Primary Care Nurse Practitioner Providers in LAFAYETTE, LA
| Name | Credential | NPI |
|---|---|---|
| MS. MARGARET GARDINER MITCHELL | NP-C | 1861711921 |
| CHESTER CORY SMITH | PHD, NP-C | 1609226422 |
| COURTNEY LEIGH CREDEUR | APRN | 1285222067 |
| ELVA ROSS | NP | 1114518685 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.