Provider Demographics
NPI:1134185580
Name:BAUMGARTNER, MOLLY HARGRAVE (APRN, NNP-C)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:HARGRAVE
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:APRN, NNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:431 SAVOIE RD
Mailing Address - Street 2:
Mailing Address - City:CANKTON
Mailing Address - State:LA
Mailing Address - Zip Code:70584-5828
Mailing Address - Country:US
Mailing Address - Phone:337-668-4115
Mailing Address - Fax:
Practice Address - Street 1:107 MONTROSE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3852
Practice Address - Country:US
Practice Address - Phone:337-981-9316
Practice Address - Fax:337-981-8303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN057173 AP01220363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal