Provider Demographics
NPI:1205293917
Name:DOUGLAS, QUENELL ZACHARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:QUENELL
Middle Name:ZACHARIE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:519 METAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4311
Mailing Address - Country:US
Mailing Address - Phone:504-838-6000
Mailing Address - Fax:504-835-6685
Practice Address - Street 1:519 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4311
Practice Address - Country:US
Practice Address - Phone:504-838-6000
Practice Address - Fax:504-835-6685
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08644363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner