Basic Information
| Provider Information | |||||||||
| NPI: | 1699748525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NUGENT | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 90507 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705090507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 N LEWIS ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705632094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 01/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 022720 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1492388 | 05 | LA | MEDICAID |