MEDICARE: NNA OF LOUISIANA, LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1427118538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NNA OF LOUISIANA, LLC

Provider Business Mailing Address
First Line	:	4899 WESTBANK EXPY
Second Line	:	SUITE B
City	:	MARRERO
State	:	LA
Zip	:	70072-3037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4899 WESTBANK EXPY
Second Line	:	SUITE B
City	:	MARRERO
State	:	LA
Zip	:	70072-3037
Country	:	US
Telephone Number	:	504-340-8577
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK R FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/02/2012

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