Healthcare Provider Details

I. General information

NPI: 1801418975
Provider Name (Legal Business Name): JANELL MONEE MATHUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 OCHSNER BLVD
GRETNA LA
70056-5246
US

IV. Provider business mailing address

1936 MAGAZINE ST
NEW ORLEANS LA
70130-5016
US

V. Phone/Fax

Practice location:
  • Phone: 504-529-5558
  • Fax:
Mailing address:
  • Phone: 504-529-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125076325
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346206
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: