Provider Demographics
NPI:1851088520
Name:HAEBERLEIN-PERRYMAN, NICOLE (CPSS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HAEBERLEIN-PERRYMAN
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66558
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6558
Mailing Address - Country:US
Mailing Address - Phone:225-922-2700
Mailing Address - Fax:225-362-5319
Practice Address - Street 1:2751 WOODDALE BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7567
Practice Address - Country:US
Practice Address - Phone:225-907-2218
Practice Address - Fax:833-734-1627
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist