Healthcare Provider Details

I. General information

NPI: 1720084510
Provider Name (Legal Business Name): BARBARA JOAN LISCUM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HIGHWAY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1514 JEFFERSON HIGHWAY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3980
  • Fax: 504-842-0041
Mailing address:
  • Phone: 504-842-3980
  • Fax: 504-842-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 090709 AP02664
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: