Provider Demographics
NPI:1306032925
Name:DISPENZA, JEANNE KATHARYN (MSN, RN, CPNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:KATHARYN
Last Name:DISPENZA
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Gender:F
Credentials:MSN, RN, CPNP
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Mailing Address - Street 1:834 WATERTON CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-3354
Mailing Address - Country:US
Mailing Address - Phone:225-765-8341
Mailing Address - Fax:225-767-6822
Practice Address - Street 1:12525 PERKINS RD
Practice Address - Street 2:STE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1907
Practice Address - Country:US
Practice Address - Phone:225-765-8341
Practice Address - Fax:225-767-6822
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2015-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX739805363LP0200X
LAAP06016363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics