Search › Louisiana › 363LP2300X
Laksamana Nusantara, NP
NPI 1205610607 · on the registry since 2023
Practice
- Address
- 401 Youngsville Hwy Ste 100
Lafayette, LA 70508 - Phone
- (337) 451-0663
- Fax
- (337) 205-8650
- Organisation at this address
- Pediatric Group Of Acadiana, Llc
Medicine Clinic Of Acadiana, LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 11
Registry record
- Primary taxonomy
- 363LP2300X
363LP2300X
- Also registered as
- 363LF0000X
- Licence states on file
- FL, LA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-10-23
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Louisiana