Healthcare Provider Details

I. General information

NPI: 1184824633
Provider Name (Legal Business Name): IJEOMA NNEKA INNOCENT-ITUAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W ESPLANADE AVE
KENNER LA
70065-2467
US

IV. Provider business mailing address

1514 JEFFERSON HIGHWAY
NEW ORLEANS LA
70121
US

V. Phone/Fax

Practice location:
  • Phone: 504-468-8600
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number674-L
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.203042
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: