Healthcare Provider Details

I. General information

NPI: 1093463291
Provider Name (Legal Business Name): CAROLINE MICHELLE BURG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 READ BLVD
NEW ORLEANS LA
70127-3106
US

IV. Provider business mailing address

3601 HOUMA BLVD STE 300
METAIRIE LA
70006-4310
US

V. Phone/Fax

Practice location:
  • Phone: 504-592-6437
  • Fax:
Mailing address:
  • Phone: 504-412-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number1477582526
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223979
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: