Provider Demographics
NPI:1780989269
Name:RIVERSIDE PRIMARY HEALTHCARE ASSOCIATES,LLC
Entity type:Organization
Organization Name:RIVERSIDE PRIMARY HEALTHCARE ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,FNP-C
Authorized Official - Phone:504-782-3849
Mailing Address - Street 1:13 LAGI ST
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-8408
Mailing Address - Country:US
Mailing Address - Phone:504-782-3849
Mailing Address - Fax:
Practice Address - Street 1:5640 READ BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3140
Practice Address - Country:US
Practice Address - Phone:504-241-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care