Individual
NICHOLAS GLEN MAGGIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11990 JACKSON ST, CLINTON, LA 70722-3210
(225) 683-5292
(225) 683-1310
Mailing address
PO BOX 395, CLINTON, LA 70722-0395
(225) 683-2529
(225) 683-1310
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
204478
LA
Other
Enumeration date
04/18/2019
Last updated
01/07/2021
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