Provider Demographics
NPI:1891454161
Name:BUGGAGE, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BUGGAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FOLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-2021
Mailing Address - Country:US
Mailing Address - Phone:225-717-2388
Mailing Address - Fax:
Practice Address - Street 1:303 HICKORY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2011
Practice Address - Country:US
Practice Address - Phone:985-446-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20150350164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse