Provider Demographics
NPI:1619084399
Name:LANDRY, CHRISTINA CORDARO (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CORDARO
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:CORDARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 98035
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898
Mailing Address - Country:US
Mailing Address - Phone:225-766-0050
Mailing Address - Fax:225-766-1499
Practice Address - Street 1:7301 HENNESSY BLVD
Practice Address - Street 2:#200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-766-0050
Practice Address - Fax:225-766-1499
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant