Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP03846 | LA |
NPI | 1235319823 |
---|---|
Provider Name | Libertad Orellana Raibstein |
First Address | Kenner, LA 70065-2467 |
Second Address | Kenner, LA 70065-2467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2007 |
Last Update Date | 27/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05650706 | (05) | MS |
1113565 | (05) | LA |