Healthcare Provider Details

I. General information

NPI: 1518220342
Provider Name (Legal Business Name): DEBRA BATTAGLIA GONZALES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 NICKLAUS ST
BERWICK LA
70342-2016
US

IV. Provider business mailing address

322 NICKLAUS ST
BERWICK LA
70342-2016
US

V. Phone/Fax

Practice location:
  • Phone: 985-413-0096
  • Fax:
Mailing address:
  • Phone: 985-413-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN074307
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: