Healthcare Provider Details

I. General information

NPI: 1134969496
Provider Name (Legal Business Name): KATHERINE CLARE ZILICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GRAVIER ST
NEW ORLEANS LA
70112-2262
US

IV. Provider business mailing address

1900 GRAVIER ST
NEW ORLEANS LA
70112-2262
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4106
  • Fax:
Mailing address:
  • Phone: 504-568-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN142789
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: