Provider Demographics
NPI:1619320520
Name:MATRANA, LAURA MISIAK (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MISIAK
Last Name:MATRANA
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:MISIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3524 MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-2325
Mailing Address - Country:US
Mailing Address - Phone:504-884-1346
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-842-4023
Practice Address - Fax:504-842-0094
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2430203Medicaid
MS02726832Medicaid
LA537526YH3UMedicare PIN