Basic Information
| Provider Information | |||||||||
| NPI: | 1396326955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAS | ||||||||
| FirstName: | JOELLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 W GRANDLAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255731610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1125 N TONTI ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701193549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048219211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2021 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 219318 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.