Healthcare Provider Details

I. General information

NPI: 1437488871
Provider Name (Legal Business Name): BIANCHINI-PELLEGRIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 MAIN ST STE 405
HOUMA LA
70360-3403
US

IV. Provider business mailing address

3939 HOUMA BLVD STE 223
METAIRIE LA
70006-2931
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-2756
  • Fax: 985-868-8986
Mailing address:
  • Phone: 504-780-1702
  • Fax: 504-780-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateLA

VIII. Authorized Official

Name: TIMOTHY PELLEGRIN
Title or Position: MEMBER
Credential: APRN, PNP
Phone: 504-780-1702