Basic Information
| Provider Information | |||||||||
| NPI: | 1811471451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REZZA | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STANN | ||||||||
| OtherFirstName: | HEATHER | ||||||||
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| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4333 CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700651319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044272114 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2750 GAUSE BLVD E | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704614149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856393777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2018 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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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 | 363LF0000X | AP10158 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.