Healthcare Provider Details

I. General information

NPI: 1790740496
Provider Name (Legal Business Name): CAROL ANN VADIEE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E SAINT BERNARD HWY
CHALMETTE LA
70043-5159
US

IV. Provider business mailing address

125 E SAINT BERNARD HWY
CHALMETTE LA
70043-5159
US

V. Phone/Fax

Practice location:
  • Phone: 504-278-1414
  • Fax: 504-278-1455
Mailing address:
  • Phone: 504-278-1414
  • Fax: 504-278-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number59065-1151
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: