Provider Demographics
NPI:1942589692
Name:PAILLE, NICOLE LAICHE (APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAICHE
Last Name:PAILLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LAICHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:985-369-1083
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:143 HIGHWAY 402
Practice Address - Street 2:SUITE 4
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-2217
Practice Address - Country:US
Practice Address - Phone:985-369-1083
Practice Address - Fax:985-369-1085
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2166000Medicaid
MS02573521Medicaid
325153YJA2Medicare PIN
3C806Medicare PIN