Provider Demographics
NPI:1265000178
Name:LOUIGEUNE, MIRTHA
Entity Type:Individual
Prefix:
First Name:MIRTHA
Middle Name:
Last Name:LOUIGEUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 W SAMPLE RD APT 301
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3247
Mailing Address - Country:US
Mailing Address - Phone:941-237-6455
Mailing Address - Fax:
Practice Address - Street 1:5880 W SAMPLE RD APT 301
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3247
Practice Address - Country:US
Practice Address - Phone:941-237-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5174504164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse