Provider Demographics
NPI:1710929328
Name:DEJONG, ESTHER BLANCHE (CNM,APRN,MP)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:BLANCHE
Last Name:DEJONG
Suffix:
Gender:F
Credentials:CNM,APRN,MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 PICHELOUP PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3822
Mailing Address - Country:US
Mailing Address - Phone:504-349-6207
Mailing Address - Fax:504-349-6272
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 250-SOUTH
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6207
Practice Address - Fax:504-349-6272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02595367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925331Medicaid