Provider Demographics
NPI:1255392593
Name:AGOSTA, LUCIE JANELLE (PHD, RNC, ANP, FNP)
Entity type:Individual
Prefix:DR
First Name:LUCIE
Middle Name:JANELLE
Last Name:AGOSTA
Suffix:
Gender:F
Credentials:PHD, RNC, ANP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 WRENWOOD BLVD
Mailing Address - Street 2:TOWNHOUSE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7711
Mailing Address - Country:US
Mailing Address - Phone:225-927-1684
Mailing Address - Fax:225-231-5575
Practice Address - Street 1:9050 AIRLINE HWY
Practice Address - Street 2:WOMAN'S HOSPITAL EMPLOYEE HEALTH SERVICES
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4103
Practice Address - Country:US
Practice Address - Phone:225-924-8144
Practice Address - Fax:225-231-5575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0056390Medicaid