Provider Demographics
NPI:1114092673
Name:MISERENDINO, ANGELA S (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:MISERENDINO
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 1:3909 LAPALCO BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2302
Mailing Address - Country:US
Mailing Address - Phone:504-349-6613
Mailing Address - Fax:504-349-6614
Practice Address - Street 1:3909 LAPALCO BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2302
Practice Address - Country:US
Practice Address - Phone:504-349-6613
Practice Address - Fax:504-349-6614
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN080155 AP03840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462331Medicaid
LA1462331Medicaid