Healthcare Provider Details

I. General information

NPI: 1003818287
Provider Name (Legal Business Name): JEFFREY J STEIN ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 N HWY 190
COVINGTON LA
70433
US

IV. Provider business mailing address

901 GAUSE BLVD STE 200
SLIDELL LA
70458-2949
US

V. Phone/Fax

Practice location:
  • Phone: 985-867-8585
  • Fax: 985-867-3644
Mailing address:
  • Phone: 985-867-8585
  • Fax: 985-867-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number082172
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: