Provider Demographics
NPI:1164969283
Name:IMPACT NURSE CONSULTING
Entity Type:Organization
Organization Name:IMPACT NURSE CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CCM
Authorized Official - Phone:225-590-6821
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70707-0182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801-1919
Practice Address - Country:US
Practice Address - Phone:225-590-6821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA117888251B00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management