Provider Demographics
NPI:1972728087
Name:STAGG, ROSEMARY A (RN FNPC)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:A
Last Name:STAGG
Suffix:
Gender:F
Credentials:RN FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3850
Mailing Address - Street 2:23515 HWY 190
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-3850
Mailing Address - Country:US
Mailing Address - Phone:985-626-6300
Mailing Address - Fax:985-626-6530
Practice Address - Street 1:23515 HWY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448
Practice Address - Country:US
Practice Address - Phone:985-626-6300
Practice Address - Fax:985-626-6530
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN045195163W00000X
LAAP04281363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043264351OtherNPI FACILITY
LA1169536Medicaid
LA1043264351OtherNPI FACILITY
LA1169536Medicaid