Provider Demographics
NPI:1336161108
Name:NETTLES, DEBORAH MARIE (MN, CNS, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MARIE
Last Name:NETTLES
Suffix:
Gender:F
Credentials:MN, CNS, FNP-C
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:MARIE
Other - Last Name:DARENSBOURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS, FNP-C
Mailing Address - Street 1:111 CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:METARIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2401
Mailing Address - Country:US
Mailing Address - Phone:504-838-5100
Mailing Address - Fax:504-838-5104
Practice Address - Street 1:111 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5450
Practice Address - Country:US
Practice Address - Phone:504-301-7727
Practice Address - Fax:504-838-5104
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03392363LF0000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1550515Medicaid
S68118Medicare UPIN
LA1550515Medicaid