Provider Demographics
NPI:1881180305
Name:MORVANT, HANNAH WAGUESPACK (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:WAGUESPACK
Last Name:MORVANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:MARIE
Other - Last Name:WAGUESPACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-S
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-0028
Mailing Address - Country:US
Mailing Address - Phone:985-625-2200
Mailing Address - Fax:985-625-2206
Practice Address - Street 1:726 N ACADIA RD STE 1000
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5009
Practice Address - Country:US
Practice Address - Phone:985-625-2200
Practice Address - Fax:985-625-2206
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant