Healthcare Provider Details

I. General information

NPI: 1265899512
Provider Name (Legal Business Name): DEBBIE ELLIOTT VI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 EARHART BLVD
NEW ORLEANS LA
70125
US

IV. Provider business mailing address

4747 EARHART BLVD
NEW ORLEANS LA
70125-1743
US

V. Phone/Fax

Practice location:
  • Phone: 504-482-2600
  • Fax: 504-482-2644
Mailing address:
  • Phone: 504-482-2600
  • Fax: 504-482-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: