Healthcare Provider Details

I. General information

NPI: 1245052539
Provider Name (Legal Business Name): JULINNA PUGH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5188 WEST ST
ANACOCO LA
71403-2826
US

IV. Provider business mailing address

PO BOX 22
ANACOCO LA
71403-0022
US

V. Phone/Fax

Practice location:
  • Phone: 337-353-9969
  • Fax:
Mailing address:
  • Phone: 337-353-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN157577
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: