Provider Demographics
NPI:1083872006
Name:MOFFATT, MARGUERITE MARY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:MARY
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53006
Mailing Address - Street 2:12875 N. SCENIC HWY
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70892-3006
Mailing Address - Country:US
Mailing Address - Phone:225-977-9245
Mailing Address - Fax:225-977-9024
Practice Address - Street 1:12875 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-1007
Practice Address - Country:US
Practice Address - Phone:225-977-9245
Practice Address - Fax:225-977-9024
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN046224 AP04314363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health