Healthcare Provider Details

I. General information

NPI: 1578978706
Provider Name (Legal Business Name): NYEMADE A RAMBO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CONSTANTIN BLVD STE 200
BATON ROUGE LA
70809-3481
US

IV. Provider business mailing address

8200 CONSTANTIN BLVD STE 200
BATON ROUGE LA
70809-3481
US

V. Phone/Fax

Practice location:
  • Phone: 225-709-8633
  • Fax: 225-098-6347
Mailing address:
  • Phone: 225-709-8633
  • Fax: 225-709-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3237000
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPENDING
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number323700
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: