Provider Demographics
NPI:1831876952
Name:MAGBANUA, JEAM-R ELAMBAYO
Entity type:Individual
Prefix:
First Name:JEAM-R
Middle Name:ELAMBAYO
Last Name:MAGBANUA
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 1:3517 N LABARRE RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3813
Mailing Address - Country:US
Mailing Address - Phone:504-982-7856
Mailing Address - Fax:
Practice Address - Street 1:2614 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-3828
Practice Address - Country:US
Practice Address - Phone:504-291-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA229928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse