Provider Demographics
NPI:1710959713
Name:WISSNER, RACHEL DREISBACH (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DREISBACH
Last Name:WISSNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:DREISBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:170 MCGEHEE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-1717
Practice Address - Country:US
Practice Address - Phone:225-272-3246
Practice Address - Fax:225-272-8899
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10782R207Q00000X
LAMD10782R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01726078Medicaid
LA1683736Medicaid
LA343091YH3VMedicare PIN
5W918Medicare ID - Type Unspecified
MS01726078Medicaid