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General NPI Number Information
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NPI Number | 1275559817
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Entity Type | Individual
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Provider Name | PATTI C. WASCOM F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 433 PLAZA ST STE 2A
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City | BOGALUSA
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State | LA
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Zip | 70427-3729
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Country | US
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Telephone | 985-730-7020
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Fax | 985-730-7022
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Provider Business Mailing Address
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Address Line | 58625 MOCSAW RD.
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City | BOGALUSA
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State | LA
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Zip | 70427
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Country | US
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Telephone | 985-730-7020
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Fax | 985-730-7022
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN055001
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP02803
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License Number State | LA
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