Basic Information
| Provider Information | |||||||||
| NPI: | 1376616532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANNA | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | ALOYSIUS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3116 6TH STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700021713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048379000 | ||||||||
| FaxNumber: | 5048378293 | ||||||||
| Practice Location | |||||||||
| Address1: | 3116 6TH STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700021713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048379000 | ||||||||
| FaxNumber: | 5048378293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 7262 | LA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1940534 | 05 | LA | MEDICAID |