Healthcare Provider Details

I. General information

NPI: 1982609764
Provider Name (Legal Business Name): ALISON BORDELON NOLAN APRN, MN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 HIGHWAY 190 EAST SERVICE RD SUITE 200
COVINGTON LA
70433-4960
US

IV. Provider business mailing address

7015 HIGHWAY 190 EAST SERVICE RD SUITE 200
COVINGTON LA
70433-4960
US

V. Phone/Fax

Practice location:
  • Phone: 985-234-3000
  • Fax:
Mailing address:
  • Phone: 985-234-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN089739 AP04522
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: