Provider Demographics
NPI:1700832441
Name:JANICE A. NUGENT, MD, LLC
Entity Type:Organization
Organization Name:JANICE A. NUGENT, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-256-5378
Mailing Address - Street 1:PO BOX 61950
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-1950
Mailing Address - Country:US
Mailing Address - Phone:337-256-5378
Mailing Address - Fax:337-256-5381
Practice Address - Street 1:520 N LEWIS ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2094
Practice Address - Country:US
Practice Address - Phone:337-256-5378
Practice Address - Fax:337-256-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1492388Medicaid
LA5CT72Medicare PIN
LA1492388Medicaid