OrganizationActive
Life Line Technologies, Inc Dba Xstrememd
NPI 1629915962 · Occupational Health Nurse Practitioner · Broussard, LA
Provider details
- NPI number
- 1629915962
- Entity type
- Organization
- Primary specialty
- Occupational Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Michael Odinet, Cmo(337) 704-0981
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1028 Forum Dr
Broussard, LA 70518-8060
Phone: (337) 704-0891
Fax: (337) 704-2974
Approximate (ZIP-level) locationGet directions
Mailing address
1028 Forum Dr
Broussard, LA 70518-8060
Other names (DBA / former)
- Doing business as
- Xstrememd
Registry dates
- Enumerated
- 2026-05-04
- Last updated
- 2026-05-04
- Certified
- 2026-05-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.