Provider Demographics
NPI:1205454899
Name:AGUILLARD, MOLLI (APRN)
Entity type:Individual
Prefix:MRS
First Name:MOLLI
Middle Name:
Last Name:AGUILLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22558 HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-8565
Mailing Address - Country:US
Mailing Address - Phone:337-789-5966
Mailing Address - Fax:
Practice Address - Street 1:3448 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5100
Practice Address - Country:US
Practice Address - Phone:337-546-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214148363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health