Female

Amanda M. Theriot FNP-BC

Family Nurse Practitioner in New Orleans, LA(View on Map)

Full Name

Amanda Mitsch Theriot FNP-BC

NPI Number

1750691812

NPI Type

Individual Provider

Gender

Female

Enumeration Date

10/07/2010

Specialties

(Taxonomies)

Code

363LF0000X

Primary Taxonomy

Yes

Licenses

State

Louisiana
Louisiana
Mississippi

License Number

AP06182
RN110773-AP06182
904786

Contact
Information

Purpose

Mailing
Location

Address

2000 CANAL ST
2000 CANAL ST

City

New Orleans
New Orleans

State

LA
LA

Postal Code

70112-3018
70112-3018

Country

US
US

Telephone Number

(504) 655-3151
(504) 655-3151

Identifiers

Identifier

2187601
60110206

Identifier State

LA
LA

Identifier Issuer

Unknown
LACARE MEDICAID PROVIDER NUMBER

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 01/04/2023

Provider Address

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