1447379912 NPI number — ELISSA S MILLMAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447379912 NPI number — ELISSA S MILLMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLMAN
Provider First Name:
ELISSA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1447379912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
167 DIANNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ROSE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70087-3742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-575-4662
Provider Business Mailing Address Fax Number:
504-303-8554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13201 RIVER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LULING
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70070-4442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-785-5800
Provider Business Practice Location Address Fax Number:
985-785-5811
Provider Enumeration Date:
03/28/2007

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: 1041C0700X , with the licence number:  4144 , 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)





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