Provider Demographics
NPI:1851150502
Name:NOLA HEALTH & WELLNESS
Entity Type:Organization
Organization Name:NOLA HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-654-7126
Mailing Address - Street 1:7257 E TAMARON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-4602
Mailing Address - Country:US
Mailing Address - Phone:504-654-7126
Mailing Address - Fax:504-438-3154
Practice Address - Street 1:3205 ORLEANS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3916
Practice Address - Country:US
Practice Address - Phone:504-438-3153
Practice Address - Fax:504-438-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1366062754Medicaid