1982767810 NPI number — DR. JESSICA J SHANK M.D.

Table of content: DR. JESSICA J SHANK M.D. (NPI 1982767810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982767810 NPI number — DR. JESSICA J SHANK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHANK
Provider First Name:
JESSICA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982767810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 TULANE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-610-7119
Provider Business Mailing Address Fax Number:
504-988-2943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 S LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-988-6300
Provider Business Practice Location Address Fax Number:
504-988-7473
Provider Enumeration Date:
12/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0201X , with the licence number:  308640 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)