Provider Demographics
NPI:1255782330
Name:MACALUSO, JAIME RICHARD (APRN)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:RICHARD
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 HOUMA BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2924
Mailing Address - Country:US
Mailing Address - Phone:504-503-6791
Mailing Address - Fax:504-393-2744
Practice Address - Street 1:4315 HOUMA BLVD SUITE 500
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-889-5250
Practice Address - Fax:504-889-5288
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN129789163W00000X
LAAP08817363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA81-3100526OtherEIN