Provider Demographics
NPI:1003290123
Name:PLAISANCE, PHOEBE RAE
Entity Type:Individual
Prefix:MS
First Name:PHOEBE
Middle Name:RAE
Last Name:PLAISANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 HICKORY AVE APT C
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2153
Mailing Address - Country:US
Mailing Address - Phone:504-874-0499
Mailing Address - Fax:
Practice Address - Street 1:1336 HICKORY AVE.
Practice Address - Street 2:APT. C
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123
Practice Address - Country:US
Practice Address - Phone:504-874-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010686233390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program