Individual
AMANDA MITSCH THERIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2000 CANAL ST, NEW ORLEANS, LA 70112-3018
(504) 655-3151
Mailing address
2000 CANAL ST, NEW ORLEANS, LA 70112-3018
(504) 655-3151
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
904786
MS
363LF0000X
Family Nurse Practitioner
Primary
AP06182
LA
363LF0000X
Family Nurse Practitioner
RN110773-AP06182
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2187601
—
LA
01
—
60110206
LACARE MEDICAID PROVIDER NUMBER
LA
Enumeration date
10/07/2010
Last updated
01/04/2023
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