Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71007074A | IN |
N | 363LG0600X | Nurse Practitioner - Gerontology | 71007074A | IN |
NPI | 1043750771 |
---|---|
Provider Name | Sonya J Lagassie |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46805-4764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 06/07/2021 |