Provider Demographics
NPI:1083060735
Name:MILAZZO, JACQUELINE JUNEAU (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:JUNEAU
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:JUNEAU
Other - Last Name:MILAZZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:7231 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3024
Mailing Address - Country:US
Mailing Address - Phone:225-315-6933
Mailing Address - Fax:
Practice Address - Street 1:7231 FRONTIER DR
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3024
Practice Address - Country:US
Practice Address - Phone:225-315-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55574163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11773355Medicare PIN