Healthcare Provider Details

I. General information

NPI: 1588406292
Provider Name (Legal Business Name): JULIA MAKITRA-BOURGEOIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BELLE CHASSE HWY
TERRYTOWN LA
70056-7127
US

IV. Provider business mailing address

120 OCHSNER BLVD
GRETNA LA
70056-5255
US

V. Phone/Fax

Practice location:
  • Phone: 504-392-3131
  • Fax:
Mailing address:
  • Phone: 504-371-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number235881
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: