Individual
PHYLLIS WAGUESPACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
1809 W AIRLINE HWY, LA PLACE, LA 70068-3336
(985) 652-8444
Mailing address
1809 W AIRLINE HWY, LA PLACE, LA 70068-3336
(985) 652-8444
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN042692
LA
Other
Enumeration date
08/25/2011
Last updated
08/25/2011
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