Healthcare Provider Details

I. General information

NPI: 1952732869
Provider Name (Legal Business Name): BRONWYN ALLEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRONWYN BACKSTROM NP

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JEFFERSON HWY
NEW ORLEANS LA
70121-2406
US

IV. Provider business mailing address

2330 JENA ST
NEW ORLEANS LA
70115-5906
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3900
  • Fax:
Mailing address:
  • Phone: 504-722-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number382418
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP08498
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: