Provider Demographics
NPI:1437887072
Name:HAEFELE, CESILIE LAURA (RN)
Entity Type:Individual
Prefix:
First Name:CESILIE
Middle Name:LAURA
Last Name:HAEFELE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N I 10 SERVICE RD W
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6867
Mailing Address - Country:US
Mailing Address - Phone:504-715-8597
Mailing Address - Fax:
Practice Address - Street 1:3925 N I 10 SERVICE RD W STE 117
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6831
Practice Address - Country:US
Practice Address - Phone:504-689-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA65-0848685Medicaid