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General NPI Number Information
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NPI Number | 1124937479
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Entity Type | Individual
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Provider Name | GABRIELLE RENEE WAGGONER
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Gender | Female
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 2510 BERT KOUNS INDUSTRIAL LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71118-3180
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Country | US
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Telephone | 318-707-2429
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Fax |
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Provider Business Mailing Address
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Address Line | 541 BRUNSWICK GDNS
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City | HAUGHTON
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State | LA
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Zip | 71037-8780
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Country | US
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Telephone | 318-707-2429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | 201123
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License Number State | LA
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