Provider Demographics
NPI:1427310796
Name:WAGUESPACK, MARCIA (R N)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:WAGUESPACK
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29170 HEALTH UNIT ST
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-4221
Mailing Address - Country:US
Mailing Address - Phone:225-265-2181
Mailing Address - Fax:225-265-7247
Practice Address - Street 1:29170 HEALTH UNIT ST
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-4221
Practice Address - Country:US
Practice Address - Phone:225-265-2181
Practice Address - Fax:225-265-7247
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN044696163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health