Healthcare Provider Details

I. General information

NPI: 1255782330
Provider Name (Legal Business Name): JAIME RICHARD MACALUSO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HOUMA BLVD SUITE 500
METAIRIE LA
70006
US

IV. Provider business mailing address

4300 HOUMA BLVD STE 202
METAIRIE LA
70006-2924
US

V. Phone/Fax

Practice location:
  • Phone: 504-889-5250
  • Fax: 504-889-5288
Mailing address:
  • Phone: 504-503-6791
  • Fax: 504-393-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08817
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP08817
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN129789
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: