Provider Demographics
NPI:1457392557
Name:NICOLETTI, PAUL H
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:H
Last Name:NICOLETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53566
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3566
Mailing Address - Country:US
Mailing Address - Phone:337-264-9787
Mailing Address - Fax:337-264-9506
Practice Address - Street 1:200 LA RUE FRANCE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3104
Practice Address - Country:US
Practice Address - Phone:337-264-9787
Practice Address - Fax:337-264-9506
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1106437Medicaid
LA1106437Medicaid
P43561Medicare UPIN