Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 014479 | LA |
NPI | 1053311530 |
---|---|
Provider Name | Dr. John F Nitsche |
First Address | Mandeville, LA 70448-4575 |
Second Address | Metairie, LA 70006-2933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 08/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004080094 | AETNA (01) | LA |
1329894 | (05) | LA |
78820 | COVENTRY (01) | LA |
B61078 | (02) | LA |