Provider Demographics
NPI:1235499864
Name:PRESTENBACK-DUFRENE, LISA (APRN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:PRESTENBACK-DUFRENE
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 1:2821 RICHLAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6830
Mailing Address - Country:US
Mailing Address - Phone:504-889-9848
Mailing Address - Fax:504-889-9844
Practice Address - Street 1:2821 RICHLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6830
Practice Address - Country:US
Practice Address - Phone:504-889-9848
Practice Address - Fax:504-889-9844
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3D21GCH24Medicare UPIN