Healthcare Provider Details

I. General information

NPI: 1780989269
Provider Name (Legal Business Name): RIVERSIDE PRIMARY HEALTHCARE ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 READ BLVD SUITE 220
NEW ORLEANS LA
70127-3140
US

IV. Provider business mailing address

13 LAGI ST
LA PLACE LA
70068-8408
US

V. Phone/Fax

Practice location:
  • Phone: 504-241-0105
  • Fax:
Mailing address:
  • Phone: 504-782-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAMIKA WHITE
Title or Position: OWNER/NURSE PRACTITIONER
Credential: APRN,FNP-C
Phone: 504-782-3849