Healthcare Provider Details

I. General information

NPI: 1730909045
Provider Name (Legal Business Name): CHARLA MICHELLE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 ULLOA ST
NEW ORLEANS LA
70119-6942
US

IV. Provider business mailing address

55 COUNTRY CLUB DR
LA PLACE LA
70068-1901
US

V. Phone/Fax

Practice location:
  • Phone: 504-267-5712
  • Fax: 504-267-5714
Mailing address:
  • Phone: 504-339-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number226848
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number226848
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: