Healthcare Provider Details

I. General information

NPI: 1902800451
Provider Name (Legal Business Name): JANINE LISSARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 JEFFERSON HWY
RIVER RIDGE LA
70123-2550
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-738-1604
  • Fax: 504-738-7860
Mailing address:
  • Phone: 504-896-9827
  • Fax: 504-894-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number023752
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: