Healthcare Provider Details

I. General information

NPI: 1073084992
Provider Name (Legal Business Name): CYNTHIA LASHLEE WARNER LAVIOLETTE MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 07/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5798
US

IV. Provider business mailing address

5312 MEMPHIS ST
NEW ORLEANS LA
70124-1736
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9732
  • Fax: 504-896-9362
Mailing address:
  • Phone: 504-650-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: