Provider Demographics
NPI:1942905708
Name:GROSSENBACHER-MCGLAMERY, AYLISSE
Entity Type:Individual
Prefix:
First Name:AYLISSE
Middle Name:
Last Name:GROSSENBACHER-MCGLAMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AYLISE
Other - Middle Name:
Other - Last Name:GROSSENBACHER-MCGLAMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 HENRY CLAY AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5720
Mailing Address - Country:US
Mailing Address - Phone:504-988-5458
Mailing Address - Fax:504-988-6808
Practice Address - Street 1:200 HENRY CLAY AVE STE 2000
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-988-5458
Practice Address - Fax:504-988-6808
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program