Individual
SIMON E WAGUESPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
SOUTHEASTERN LOUISIANA UNIVERSITY, HAMMOND, LA 70402-0001
(800) 222-7358
Mailing address
29781 MACON DR, ALBANY, LA 70711-3511
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/14/2019
Last updated
03/14/2019
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