Provider Demographics
NPI:1659490217
Name:HART, JENNIFER NIELSEN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NIELSEN
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GRAVIER ST
Mailing Address - Street 2:DEPT. OF INTERNAL MEDICINE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2272
Mailing Address - Country:US
Mailing Address - Phone:504-568-6097
Mailing Address - Fax:
Practice Address - Street 1:1450 POYDRAS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-6010
Practice Address - Country:US
Practice Address - Phone:504-903-1084
Practice Address - Fax:504-903-5164
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1966258Medicaid
LA1966258Medicaid
LAF56393Medicare UPIN
LA5R645F669Medicare PIN
LA370011084Medicare PIN