Provider Demographics
NPI:1447464961
Name:FLUGENCE, PEARLIE B
Entity type:Individual
Prefix:MRS
First Name:PEARLIE
Middle Name:B
Last Name:FLUGENCE
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 1:403 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-3520
Mailing Address - Country:US
Mailing Address - Phone:337-886-0108
Mailing Address - Fax:337-886-1413
Practice Address - Street 1:403 VETERANS DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3520
Practice Address - Country:US
Practice Address - Phone:337-886-0108
Practice Address - Fax:337-886-1413
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4444261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131369OtherPROVIDER NUMBER