Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP09890 | LA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | AP09890 | LA |
NPI | 1013412444 |
---|---|
Provider Name | Ailenne Lizet Coulon |
First Address | New Orleans, LA 70154-4647 |
Second Address | Chalmette, LA 70043-5405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2466259 | (05) | LA |