Provider Demographics
NPI:1538460845
Name:PLAUCHE, LISA B (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:PLAUCHE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W. ESPLANADE AVE
Mailing Address - Street 2:ST. 410
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:504-464-8090
Mailing Address - Fax:504-464-8194
Practice Address - Street 1:200 W. ESPLANADE AVE
Practice Address - Street 2:ST. 410
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-464-8090
Practice Address - Fax:504-464-8194
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06278363L00000X
LARN116064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00606517Medicaid
LA2130838Medicaid
LA2130838Medicaid