Provider Demographics
NPI:1720553100
Name:MAUGER, LOUISE C (RN)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:C
Last Name:MAUGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:C
Other - Last Name:CASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S STE 2700
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5509
Mailing Address - Country:US
Mailing Address - Phone:585-295-2925
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS HWY S STE 2700
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-5509
Practice Address - Country:US
Practice Address - Phone:585-295-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296591163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management