Healthcare Provider Details

I. General information

NPI: 1871241182
Provider Name (Legal Business Name): COLLABORATIVE HEALTH NOLA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 IDAHO AVE
KENNER LA
70062-5715
US

IV. Provider business mailing address

PO BOX 295
MANDEVILLE LA
70470-0295
US

V. Phone/Fax

Practice location:
  • Phone: 504-466-0222
  • Fax:
Mailing address:
  • Phone: 504-345-6217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NIKESHA GUICE DUPLESSIS
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 504-345-6217