Healthcare Provider Details

I. General information

NPI: 1356088025
Provider Name (Legal Business Name): LAIQ ROBIN-MARCOMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5798
US

IV. Provider business mailing address

2733 ASCENSION CT
MARRERO LA
70072-6089
US

V. Phone/Fax

Practice location:
  • Phone: 504-346-7048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number225305
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: