Provider Demographics
NPI:1619432705
Name:WAGUESPACK, ELAINE MARIE (APRN - FNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:WAGUESPACK
Suffix:
Gender:F
Credentials:APRN - FNP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MARIE
Other - Last Name:WAGUESPACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN - FNP
Mailing Address - Street 1:803 ALBERTSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4349
Mailing Address - Country:US
Mailing Address - Phone:337-889-5364
Mailing Address - Fax:337-232-0477
Practice Address - Street 1:803 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4349
Practice Address - Country:US
Practice Address - Phone:337-889-5364
Practice Address - Fax:337-232-0477
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10134363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner