Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | MD.13592R | LA |
Y | 2080P0204X | Pediatric Emergency Doctor | ME75420 | LA |
NPI | 1366453888 |
---|---|
Provider Name | Jerussa Maria Aita-Levy |
First Address | New Orleans, LA 70112-1221 |
Second Address | New Orleans, LA 70118-5720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 01/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03573534 | (05) | MS |
1434973 | (05) | LA |
H26661 | (02) |