Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 0024166794 | VA |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP08054 | LA |
NPI | 1073639308 |
---|---|
Provider Name | Cynthia Kay Lagrange |
First Address | Lake Charles, LA 70605-0452 |
Second Address | Lake Charles, LA 70605-0452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 19/04/2017 |