Healthcare Provider Details

I. General information

NPI: 1891915468
Provider Name (Legal Business Name): STEPHANIE LOUISE GRAVOIS-RUPE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 CANAL ST
NEW ORLEANS LA
70112-2703
US

IV. Provider business mailing address

905 OLD METAIRIE PL
METAIRIE LA
70001-6085
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-7829
  • Fax:
Mailing address:
  • Phone: 504-234-8513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number026085
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: