MEDICARE: DEIDRA LEWIS PIERRE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN051922	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN051922	OTHER	LA	STATE LICENSE

General Provider Information

NPI Number	:	1346459567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRA LEWIS PIERRE NP

Provider Business Mailing Address
First Line	:	1541 TULANE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 TULANE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2821
Country	:	US
Telephone Number	:	504-903-1301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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