Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN057173 AP01220 | LA |
NPI | 1134185580 |
---|---|
Provider Name | Ms. Molly Hargrave Baumgartner |
First Address | Cankton, LA 70584-5828 |
Second Address | Lafayette, LA 70503-3852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |