Healthcare Provider Details

I. General information

NPI: 1679192512
Provider Name (Legal Business Name): NICOLE DANIELLE NAMMOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE DANIELLE NAMMOUR MD

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 COURT AVE RM 308
MEMPHIS TN
38103-2814
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5814
  • Fax:
Mailing address:
  • Phone: 504-842-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number341171
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: