1841665874 NPI number — LEE ANN GURGANIOUS M.S.

Table of content: LEE ANN GURGANIOUS M.S. (NPI 1841665874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841665874 NPI number — LEE ANN GURGANIOUS M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GURGANIOUS
Provider First Name:
LEE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
URREY
Provider Other First Name:
LEE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841665874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MARINERS PLAZA DR
Provider Second Line Business Mailing Address:
SUITE603
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70448-6822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-465-4250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1403 METRO DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-3454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-445-9019
Provider Business Practice Location Address Fax Number:
318-445-1098
Provider Enumeration Date:
12/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com