Provider Demographics
NPI:1598010605
Name:MCCLOSKEY, MICHELLE ANDREA (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANDREA
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MACALUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4520 WICHERS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3135
Mailing Address - Country:US
Mailing Address - Phone:504-754-2334
Mailing Address - Fax:504-324-2078
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:SUITE 950
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6969
Practice Address - Country:US
Practice Address - Phone:504-842-5300
Practice Address - Fax:504-842-5305
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2316184Medicaid
LA2316184Medicaid