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General NPI Number Information
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NPI Number | 1871241182
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE HEALTH NOLA, LLC
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 2401 IDAHO AVE
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City | KENNER
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State | LA
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Zip | 70062-5715
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Country | US
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Telephone | 504-466-0222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 295
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City | MANDEVILLE
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State | LA
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Zip | 70470-0295
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Country | US
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Telephone | 504-345-6217
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | NIKESHA GUICE DUPLESSIS
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Credential |
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Telephone | 504-345-6217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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