Provider Demographics
NPI:1619189891
Name:HARMON, ELAINE V (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:V
Last Name:HARMON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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:#103
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:504-464-8712
Mailing Address - Fax:504-464-8711
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:#103
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-464-8712
Practice Address - Fax:504-464-8711
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04227363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP04227OtherNPL
LARN082473OtherNPL
LA1945714Medicaid
LA1945714Medicaid