Provider Demographics
NPI:1619484011
Name:DAIGLE, LAUREN GRACE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:GRACE
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-5526
Mailing Address - Country:US
Mailing Address - Phone:225-588-9484
Mailing Address - Fax:
Practice Address - Street 1:308 N AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3009
Practice Address - Country:US
Practice Address - Phone:225-647-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPNT.048016390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program