Provider Demographics
NPI:1295363315
Name:AMMAN, FREDERIC
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:
Last Name:AMMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5624
Mailing Address - Country:US
Mailing Address - Phone:504-881-5075
Mailing Address - Fax:
Practice Address - Street 1:5325 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5624
Practice Address - Country:US
Practice Address - Phone:504-881-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10009694367500000X
LA226194367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered