Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN086560 | LA |
NPI | 1063426047 |
---|---|
Provider Name | Virginia M Pellegrin |
First Address | Houma, LA 70360-4705 |
Second Address | Houma, LA 70360-4705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1537667 | (05) | LA |
P25214 | (02) | LA |