Healthcare Provider Details

I. General information

NPI: 1609005404
Provider Name (Legal Business Name): DONNA RACHEL DAVILLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 WILLIAMS BLVD
KENNER LA
70065-2202
US

IV. Provider business mailing address

4033 TCHOUPITOULAS ST
NEW ORLEANS LA
70115-1432
US

V. Phone/Fax

Practice location:
  • Phone: 504-239-1901
  • Fax:
Mailing address:
  • Phone: 504-410-4197
  • Fax: 504-324-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLA2162
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: