Provider Demographics
NPI:1588195341
Name:WAGUESPACK, ANN M (RDMS)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:WAGUESPACK
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:WAGUESPACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDMS
Mailing Address - Street 1:9736 KINGLET DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4611
Mailing Address - Country:US
Mailing Address - Phone:225-978-4909
Mailing Address - Fax:
Practice Address - Street 1:9736 KINGLET DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4611
Practice Address - Country:US
Practice Address - Phone:225-978-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QH0100X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service