Provider Demographics
NPI:1720084510
Name:LISCUM, BARBARA JOAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JOAN
Last Name:LISCUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-3980
Mailing Address - Fax:504-842-0041
Practice Address - Street 1:1514 JEFFERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3980
Practice Address - Fax:504-842-0041
Is Sole Proprietor?:No
Enumeration Date:2005-06-26
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 090709 AP02664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1161411Medicaid
MS07086281Medicaid
LA353582YH3UMedicare PIN
MS07086281Medicaid
Q30472Medicare UPIN