Healthcare Provider Details

I. General information

NPI: 1558408062
Provider Name (Legal Business Name): JENNIFER HINRICHSEN MARAIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 GATEWAY DR STE B
SLIDELL LA
70461-5540
US

IV. Provider business mailing address

1114 ZACHARY DR
SLIDELL LA
70461-5342
US

V. Phone/Fax

Practice location:
  • Phone: 985-645-8687
  • Fax:
Mailing address:
  • Phone: 504-858-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number025633
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: