Individual
DUSTIN DAVID DENICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
4950 ESSEN LN, SUITE 300, BATON ROUGE, LA 70809-3738
(225) 490-8882
(225) 765-9085
Mailing address
PO BOX 84460, BATON ROUGE, LA 70884-4460
(225) 526-6001
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN117110-AP06574
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00985562
—
MS
05
—
2314815
—
LA
Enumeration date
04/10/2012
Last updated
03/23/2017
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