Healthcare Provider Details

I. General information

NPI: 1942905708
Provider Name (Legal Business Name): AYLISSE GROSSENBACHER-MCGLAMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AYLISE GROSSENBACHER-MCGLAMERY

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE STE 2000
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

200 HENRY CLAY AVE STE 2000
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5458
  • Fax: 504-988-6808
Mailing address:
  • Phone: 504-988-5458
  • Fax: 504-988-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number352364
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: