Provider Demographics
NPI:1972929651
Name:NORMAN, DEANTA S (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEANTA
Middle Name:S
Last Name:NORMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEANTA
Other - Middle Name:S
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:ATTN. JUDY DANNA. BENSON TOWER 25TH FLOOR
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:225-939-3148
Mailing Address - Fax:
Practice Address - Street 1:9001 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3726
Practice Address - Country:US
Practice Address - Phone:225-761-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02831868OtherMS. MEDICAID
LA2368028Medicaid
LA3590524H3VMedicare PIN