Healthcare Provider Details

I. General information

NPI: 1801204680
Provider Name (Legal Business Name): MICHELLE O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 02/22/2016
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

3757 LAKE LYNN DR
GRETNA LA
70056-8336
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3470
  • Fax: 504-842-7372
Mailing address:
  • Phone: 504-881-9020
  • Fax: 504-575-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP07882
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: