Healthcare Provider Details

I. General information

NPI: 1316342165
Provider Name (Legal Business Name): EMILY BREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY POWELL

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

222 PRINCETON CIR
BELLE CHASSE LA
70037-1310
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3000
  • Fax: 504-842-0467
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number08055
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146313
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: