MEDICARE: MS. NANCY DENISE PHERIGO R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN069085	LA

General Provider Information

NPI Number	:	1649326364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY DENISE PHERIGO R.N.

Provider Business Mailing Address
First Line	:	4037 HIGHWAY 306
Second Line	:
City	:	DES ALLEMANDS
State	:	LA
Zip	:	70030-3421
Country	:	US
Telephone Number	:	985-652-8444
Fax Number	:	985-652-2450

Provider Business Practice Location Address
First Line	:	1808 W AIRLINE HWY
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-3335
Country	:	US
Telephone Number	:	985-652-8444
Fax Number	:	95-652-2450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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