Healthcare Provider Details

I. General information

NPI: 1740042183
Provider Name (Legal Business Name): MELISSA FIGUEREDO TARAVELLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PAUL MAILLARD RD
LULING LA
70070-4349
US

IV. Provider business mailing address

117 LAKE CAROLYN DR
LULING LA
70070-3143
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-3740
  • Fax:
Mailing address:
  • Phone: 504-234-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number234356
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: