1942589692 NPI number — NICOLE LAICHE PAILLE APRN

Table of content: NICOLE LAICHE PAILLE APRN (NPI 1942589692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942589692 NPI number — NICOLE LAICHE PAILLE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAILLE
Provider First Name:
NICOLE
Provider Middle Name:
LAICHE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAICHE
Provider Other First Name:
NICOLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942589692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 S SHERWOOD FOREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-369-1083
Provider Business Mailing Address Fax Number:
225-765-9196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 HIGHWAY 402
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
NAPOLEONVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70390-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-369-1083
Provider Business Practice Location Address Fax Number:
985-369-1085
Provider Enumeration Date:
08/12/2011

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: 363LF0000X , with the licence number:  AP06579 , 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)

  • Identifier: 2166000 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02573521 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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