Provider Demographics
NPI:1174410971
Name:NOLA 504 NP LLC
Entity type:Organization
Organization Name:NOLA 504 NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRESTENBACK-DUFRENE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-329-0403
Mailing Address - Street 1:601 MANSON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-4826
Mailing Address - Country:US
Mailing Address - Phone:504-210-0890
Mailing Address - Fax:855-452-4557
Practice Address - Street 1:2832 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-2514
Practice Address - Country:US
Practice Address - Phone:504-866-2741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty