MEDICARE: CONNIE R BOULIGNY FNP

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	35423 02872	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598810129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE R BOULIGNY FNP

Provider Business Mailing Address
First Line	:	5459 STILLWATER DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-3412
Country	:	US
Telephone Number	:	504-390-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 POYDRAS STREET
Second Line	:	1934
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2401
Country	:	US
Telephone Number	:	504-568-8195
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/15/2015

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Directions to “ CONNIE R BOULIGNY FNP” Practice Location

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