Healthcare Provider Details

I. General information

NPI: 1356352876
Provider Name (Legal Business Name): LEIGH ANNE GEISLER BURNS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 GRAVIER ST SUITE 613
NEW ORLEANS LA
70112-2260
US

IV. Provider business mailing address

1340 POYDRAS ST
NEW ORLEANS LA
70112-1221
US

V. Phone/Fax

Practice location:
  • Phone: 504-412-1860
  • Fax:
Mailing address:
  • Phone: 504-412-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number780
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: