Provider Demographics
NPI:1629205315
Name:PENNEBAKER, MELISSA L (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:PENNEBAKER
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Gender:F
Credentials:NP
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Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3525 PRYTANIA ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3500
Practice Address - Country:US
Practice Address - Phone:504-897-8970
Practice Address - Fax:504-897-8777
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2010-11-03
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Provider Licenses
StateLicense IDTaxonomies
LAAP03897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1893528Medicaid
LA3B148Medicare PIN