Provider Demographics
NPI:1275559817
Name:WASCOM, PATTI C (FNP)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:C
Last Name:WASCOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58625 MOCSAW RD.
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427
Mailing Address - Country:US
Mailing Address - Phone:985-730-7020
Mailing Address - Fax:985-730-7022
Practice Address - Street 1:433 PLAZA ST STE 2A
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3729
Practice Address - Country:US
Practice Address - Phone:985-730-7020
Practice Address - Fax:985-730-7022
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN055001363L00000X
LAAP02803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1694207Medicaid
LA1694207Medicaid
LA5X026Medicare ID - Type Unspecified