Basic Information
| Provider Information | |||||||||
| NPI: | 1538615497 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AISOLA | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 GUERRA DR | ||||||||
| Address2: | |||||||||
| City: | VIOLET | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700922918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046069168 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2626 CHARLES DR STE 211 | ||||||||
| Address2: | |||||||||
| City: | CHALMETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700433779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042784006 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2016 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.