Healthcare Provider Details

I. General information

NPI: 1548768856
Provider Name (Legal Business Name): AUNGELLE MICHELLE LYTELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUNGELLE SAVOIE

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 701
BATON ROUGE LA
70808-4370
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-5864
  • Fax: 225-765-2013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP09789
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: