1205454899 NPI number — MRS. MOLLI AGUILLARD APRN

Table of content: MRS. MOLLI AGUILLARD APRN (NPI 1205454899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205454899 NPI number — MRS. MOLLI AGUILLARD APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGUILLARD
Provider First Name:
MOLLI
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205454899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22558 HIGHWAY 26
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENNINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70546-8565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-789-5966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3448 HIGHWAY 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUNICE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70535-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-546-6237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2020

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: 363LW0102X , with the licence number:  214148 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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