Healthcare Provider Details

I. General information

NPI: 1245714997
Provider Name (Legal Business Name): JALEESA CHANTELL CARPRUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 FORSYTHE BYP STE 114
MONROE LA
71201-2168
US

IV. Provider business mailing address

3157 GENTILLY BLVD STE 2035
NEW ORLEANS LA
70122-3872
US

V. Phone/Fax

Practice location:
  • Phone: 318-450-8828
  • Fax:
Mailing address:
  • Phone: 888-884-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: