Healthcare Provider Details

I. General information

NPI: 1811471451
Provider Name (Legal Business Name): HEATHER S. REZZA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER STANN FNP

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 GAUSE BLVD E
SLIDELL LA
70461-4149
US

IV. Provider business mailing address

4333 CALIFORNIA AVE
KENNER LA
70065-1319
US

V. Phone/Fax

Practice location:
  • Phone: 985-639-3777
  • Fax:
Mailing address:
  • Phone: 504-427-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10158
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: