Provider Demographics
NPI:1346698990
Name:USNER, NICHOLAS J (PA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:USNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:STE 21
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2931
Mailing Address - Country:US
Mailing Address - Phone:504-885-6464
Mailing Address - Fax:504-885-8993
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:STE 21
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2931
Practice Address - Country:US
Practice Address - Phone:504-885-6464
Practice Address - Fax:504-885-8993
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA302033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2422049Medicaid
LA345088YRBTMedicare PIN