Basic Information
| Provider Information | |||||||||
| NPI: | 1598907297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARPER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | PINO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 HEYMANN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372343344 | ||||||||
| FaxNumber: | 3372343352 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 HEYMANN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372343344 | ||||||||
| FaxNumber: | 3372343352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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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 | 207V00000X | MD.206054 | LA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 206054 | 01 | LA | LICENSE | OTHER | 043121 | 01 | LA | CDS | OTHER | 1965073 | 05 | LA | MEDICAID | 1659688489 | 01 | LA | GROUP NPI | OTHER | FH3881150 | 01 | LA | DEA | OTHER | 304417YJOA | 01 | LA | MEDICARE GRP MEMBER PTAN | OTHER |