Healthcare Provider Details

I. General information

NPI: 1831902691
Provider Name (Legal Business Name): TALISE E HERMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 LAKE CATHERINE DR
LULING LA
70070-3147
US

IV. Provider business mailing address

105 SOPHIA DR
LULING LA
70070-4208
US

V. Phone/Fax

Practice location:
  • Phone: 504-717-8993
  • Fax:
Mailing address:
  • Phone: 504-717-8993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239591
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: