Provider Demographics
NPI:1083994263
Name:DEMESIA, SUSAN M (APRN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:DEMESIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SAN CARLOS AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2239
Mailing Address - Country:US
Mailing Address - Phone:504-232-2235
Mailing Address - Fax:504-232-2235
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-468-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2178423Medicaid
MS06000067Medicaid